Family Medicine Expert Opines on Sinus Infection That Leads To Blindness

Case Overview

This case involves a young woman who had a fever and congestion for a week. The patient’s vitals were normal but her white blood cell count was elevated. She was told to take over-the-counter cold medication and was sent home. The next day, the patient still felt ill so she went to a family medicine doctor. At this point, the patient had severe sinus congestion, extreme nasal discharge, swollen lymph nodes, and an even higher WBC count. The family doctor diagnosed her with possible flu and prescribed antibiotics to be taken only if symptoms did not clear up by the end of the week. In the days that followed, the patient’s eyes began to protrude and she was advised to return to the hospital. A CT showed inflammation of the eye tissues behind the orbital septum and infection in the eye socket from the sinuses. An ENT immediately operated to remove the infected tissues blocking sinus drainage. The following day, the patient had fixed pupils with no vision. Despite many additional surgeries, the patient was rendered permanently blind.

Questions to the Internal Medicine expert and their responses

How often do you treat patients similar to the one in this case?

I see patients frequently for the diagnosis of acute sinusitis.

What goes into the decision of whether to give patients antibiotics (length/type of symptoms, degree of fever)?

The two features that are typically most helpful to diagnose an acute sinus infection that could be helped by an antibiotic are the duration of symptoms and the sick-well-sick pattern of illness. If the symptoms have been present for 10 days or more, the likelihood of a bacterial infection, and benefit from an antibiotic, increase. Similarly, if the patient was sick, got better, and then got sick again (double sickening syndrome or sick-well-sick pattern), this pattern suggests that the patient had a viral upper respiratory infection that then turned into a bacterial one.

What goes into decision making of whether to send a patient to the ED?

I would not have sent the patient to the ED at that family medicine office visit. It sounded like an acute bacterial sinusitis, at most; and the patient needed to be started on an antibiotic.

About the expert

This highly qualified, board-certified family medicine specialist has authored a vast body of medical publications and is a nationally recognized lecturer in his field. He earned his BA from Harvard University and his MD from Case Western Reserve University. He then went on to complete his residency in family medicine at the Medical University of South Carolina. Throughout his 30-year medical career, he has held several high ranking clinical and academic medical positions in his field. He currently serves as a tenured professor of family medicine at a major medical university in South Carolina, as well as an attending physician of family medicine at two large regional medical centers.