Neurological Complications of Acute Rhinosinusitis: Meningitis

Meningitis remains a rare but potentially life-threatening intracranial complication of acute rhinosinusitis. We describe a case of a 62-year-old man with a background of chronic rhinosinusitis who presented to hospital with confusion, fever and bilateral green purulent rhinorrhoea. After immediate sepsis management, urgent contrast-enhanced computed tomography head revealed opacification of all paranasal sinuses and bony erosion of the lateral walls of both ethmoid sinuses. He was treated with intravenous antibiotics, topical nasal steroids, decongestants and irrigation. Following a turbid lumbar puncture and multidisciplinary discussion, he was admitted to the critical care unit and later intubated due to further neurological deterioration. After 13 days admission and rehabilitation in the community he made a good recovery. This case highlights the importance of timely diagnosis and appropriate management of acute rhinosinusitis and awareness of the possible complications. Joint care with physicians and intensivists is crucial in the management of these sick patients.