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. 2014:2014:601671.
doi: 10.1155/2014/601671. Epub 2014 Aug 21.

Intracranial complication of rhinosinusitis from actinomycosis of the paranasal sinuses: a rare case of abducens nerve palsy

G L Fadda  1 , M Gisolo  1 , E Crosetti  2 , A Fulcheri  1 , G Succo  1
Affiliations

Intracranial complication of rhinosinusitis from actinomycosis of the paranasal sinuses: a rare case of abducens nerve palsy

G L Fadda et al. Case Rep Otolaryngol. 2014.

Abstract

Sinonasal actinomycosis should be suspected when a patient with chronic sinusitis does not respond to medical therapy or has a history of facial trauma, dental disease, cancer, immunodeficiency, long-term steroid therapy, diabetes, or malnutrition. Radiological evaluation with computed tomography and magnetic resonance imaging are important in differential diagnosis, evaluating the extent of disease, and understanding clinical symptoms. Endoscopic sinus surgery associated with long-term intravenous antibiotic therapy is the gold standard for treatment of sinonasal actinomycosis. We report an unusual case of abducens nerve palsy resulting from invasive sinonasal actinomycosis in a patient with an abnormally enlarged sphenoid sinus. A review of the current literature highlighting clinical presentation, radiological findings, and treatment of this uncommon complication is also presented.

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Figures

Figure 1
Figure 1
Photo of the patient at admission. Note the absence of motility of the left eye in the lateral gaze related to the deficit of the left lateral rectus muscle for abducens nerve palsy.
Figure 2
Figure 2
Maxillofacial and brain CT (a, b) and MRI (c, d). (a) Axial CT with contrast medium and (c) MRI-T1 weighted sequence showing abnormal extension of the left sphenoid sinus with thinning of the posterior and lateral bony walls (arrows) and compression of the temporal lobe (asterisk). (b) Coronal CT showing opacification of almost all paranasal sinuses associated with a focal erosion of the papyracea lamina (arrows). (d) Coronal T2-weighted MRI image showing temporal lobe compression (asterisk), while the left abducens nerve and cavernous sinus are not clearly recognizable.
Figure 3
Figure 3
Actinomycetes can be seen forming colonies of filamentous sulfur granules surrounded by numerous polymorphonuclear cells (hematoxylin and eosin staining, 40x).
Figure 4
Figure 4
(a) Photo of the patient at three months after ESS showing complete recovery from left abducens nerve palsy. (b) Axial MRI performed one month after surgery. Enlargement of the left sphenoid sinus and resolution of the disease can be seen.
See this image and copyright information in PMC

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