Intracranial Complication of Rhinosinusitis from Actinomycosis of the Paranasal Sinuses: A Rare Case of Abducens Nerve Palsy

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.

Actinomycosis arising from the nasal cavity, with rare fatal progression

“…It can also be classified as invasive or non-invasive type according to the manner of progression to the surrounding organs,3 4 which is useful in deciding treatment options.…”

“…Imaging to help determine a clinical diagnosis includes enhanced CT, MRI, ultrasonography, Ga scintigraphy and bone scintigraphy 4 9. Enhanced CT imaging is the most important technique and often shows a diffuse contrasting effect that indicates tumorous shadowing or a ring enhancement, which indicates the presence of an abscess 9.…”

“…Since mixed infection with other bacteria affects the pathological progression of actinomycosis, these surgical procedures are important to control the infections and to increase the concentration of the antibiotics at the infection sites. It has been reported that a sole antibiotic treatment is not effective against paranasal actinomycosis,3 4 and the removal of the necrotic tissue by endoscopic sinus surgery is required before administering antibiotics for an appropriate period.…”

Comparative study between diagnostic nasal endoscopy and computed tomography of PNS in sino nasal diseases

“…In the study conducted by Fadda et al pneumatised uncinate process is noted in 1(0.7%) case on the right and 4(2.8%) on left. 11 On comparison both the studies shows almost equal percentage of patients with pneumatised uncinate.…”

063 Actinomyces cavernous sinus infection: a case and systematic literature review

“…In our study we were unable to identify Actinomyces from 16S rRNA amplification due to a poor quality mixed read, potentially reflecting polymicrobial infection. Actinomyces infections are often polymicrobial as tissue invasion via mucosal surfaces may be accompanied by other commensal bacteria, which help facilitate infection by creating a microaerophilic environment (2,9,15). All eight prior reports described successful treatment with penicillin between two to six-months duration.…”