Complicated chronic rhinosinusitis: A fatal case in a patient with thalassemia and Crouzon syndrome

Sinus infections are a common complaint in the emergency department. Although most cases represent acute infection, patients may present with chronic symptoms, often with minimal long-term complications. A 24-year-old male with a history of Crouzon syndrome (Craniosynostosis), thalassemia, and chronic sinus headaches refractory to oral antibiotics and steroids presented to our ED with new-onset altered mental status (AMS) and septic shock. CT revealed evidence of extensive odontogenic sinusitis, multifocal deossification, and presumptive right frontal lobe intraparenchymal abscess. The patient was admitted to the ICU but rapidly decompensated and suffered uncal herniation leading to brain death soon after admission. The diagnosis of brain abscess secondary to sinus infection was eventually confirmed on autopsy and nasal aspirate culture. While fatal complications of chronic sinusitis are rare, this case illustrates that the emergency clinician should have a low threshold for admission, imaging, lumbar puncture, and use of intravenous (IV) and intramuscular (IM) antibiotics in patients with thalassemia, congenital structural facial dyscrasias, or sinusitis refractory to oral antibiotics due to the concern for potential meningitis and brain abscess.