Brain abscess in adolescent caused by complicated sinusitis: a case report

Case presentation: A 11-year-old girl, weighing 39 kg, evolved with severe headache, fever, and vomiting. Her computed tomography (CT) brain was normal, but sinus CT evidenced lesions in the right maxillary, ethmoid, and frontal sinuses. Antibiotics were administered for sinusitis intra-hospital for 6 days, and amoxicillin/clavulanate was prescribed for the ambulatorial treatment for 10 days. However, after 9-day, the patient developed seizures. Due to worsening symptoms and evidence in a new brain CT of brain abscess in the frontal lobe, she was referred to our hospital taking ceftriaxone, clindamycin, and phenytoin for evaluation of neurosurgery 40 days after symptom onset. Laboratory results: WBC of 19,100; CRP of 98; hemoculture and pharyngeal swab negatives. An intravenous combination of clindamycin, vancomycin, cefepime, and carbamazepine was given. Surgical drainage with Porto-Vac was done and referred to ICU. She did well without continued seizure activity.

Discussion: Acute sinusitis is prevalent in children, but it rarely may evaluate intracranial complications as brain abscesses may introduce symptoms such as progressively worsening headache, pyrexia, vomiting, and seizure. The literature describes intracranial complications of pediatric sinusitis most frequently in mean age 11.9–13.3 years and male. They most commonly involving the epidural space and often require neurosurgical intervention such as craniotomy. Cultures rarely are negative, unlike our case report. Unfortunately, a CT scan, initially may not reveal findings in the parenchymal brain as reported, resulting in complicated sinusitis due to late diagnosis. Prolonged intravenous antibiotic treatment and a greater overall hospital length of stay are required. Intracranial abscess recurrence was associated with involvement of brain parenchyma as occurred with this patient.

Final comments: Parenchymal abscesses from complicated sinusitis are uncommon, but it's important to recognize warning signs, give attention to persistent symptoms, and earlier diagnoses, and improve imaging techniques and culturing techniques. Successful management consists of antibiotic therapy combined with surgical drainage of loculated infection.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023