2018 Volume 39 Issue 1 Pages 38-43
Among pediatric patients, severely disabled children often develop sinusitis due to tracheotomy or nasogastric intubation. We herein report a case in which a patient developed repeated paranasal sinus infection. Paranasal sinus seemed to expand due to congenital cerebral hypomyelination.
The patient was a 13-year old girl with severe physical and mental disorder who had been diagnosed with seizure attack and dystonia from 7 months of age. Head MRI revealed hypomyelination with atrophy of the basal ganglia and cerebellum. At 13 years, she experienced recurrent fever. Head CT images revealed prominent bilateral paranasal sinus enlargement, mucosal hypertrophy and liquid retention and acute sinusitis was diagnosed.
Although these abnormal findings initially improved with antibacterial treatment, an exacerbation occurred. Due to a lack of improvement, endoscopic paranasal sinus surgery was performed. Although liquid retention remained after surgery, the frequency of infection significantly decreased with the oral administration of a small amount of macrolide antibiotics and expectorants. In infants with a history of central nervous system disorder, it is possible that the sinus cavities may expand due to brain atrophy and that the condition could become difficult to treat.
