Presented by 3rd semester MBBS 2015 batch Prodymna Kundu
A 60 year old man was admitted
to the hospital with
chief complaints of pain around the eyes, base & margins of
the nose & back of the head, along with severe anemia.
The pain has been a consistent problem for the
last 5 years. Earlier it was a mild pain but has increased gradually over the
time. Pain is mostly stimulated by colder objects and dust. Recently the pain
has been observed to increase on sudden exposure to sunlight & music at
high level induces the pain.
Complaints of dizziness
vomiting and nausea were also present. Breathing problems may be present as the
patient was not able to speak at lengths and had to be given considerable time
to speak.
There is no fixed duration
and onset of pain.
The patient is also suffering
from Diabetes DM 2 since 10 years for
which he is currently on Insulin
BP has been normal.
No history of Epilepsy and TB
His elder brother had similar problems of headache and his sister is also diabetic.
Parents had diabetes.
No drug allergy or allergy from other substances. The patient does not smoke.
No history of blood transfusion.
Clinical findings were suggestive of severe anemia and on investigations the Hb was 3 g%
A CT paranasal sinuses done outside were suggestive of a mass in his left maxillary sinus.
The patient was evaluated by the ENT team and a nasal endoscopy revealed blood and mucus in the left maxillary sinus which was drained but no smear for gm stain or fungus was sent
The patient was treated further with Blood transfusion for his anemia and Insulin was continued for his Diabetes.
Conversational clinical decision support:
Comments
So, poorly controlled diabetes with maxillary sinusitis? Wow!
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