R. NICKBRYANMDS. JAMESZINREICHMD
A 32-YEAR-OLD WOMAN presented with a 5-year history of chronic rhinosinusitis and headaches that had resulted in 3 surgeries by 2 different surgeons over the past 5 years. Her main complaints consisted of a searing left retro-orbital headache, postnasal drip, ear pain, and recurrent rhinosinusitis. She had been treated with multiple antibiotics over several months, without improvement, and cultures had yielded both Staphylococcus aureus and Pseudomonas on various occasions. Her physical examination was remarkable only for the results of nasal endoscopy, which revealed a clean ethmoid cavity on the right, with slight frontal recess edema, and a clean left ethmoid cavity. The results of allergy testing were negative; however, immunoglobulin screening showed a borderline IgA deficiency. Evaluations by neurologists resulted in recommendations for treatment with migraine medications, and an infectious disease evaluation resulted in a recommendation for antiherpetic medication. A computed tomographic (CT) scan was obtained and is shown in Figure 1.
Allmond L, Murr AH. Radiology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2002;128(5):596. doi:10.1001/archotol.128.5.596