Occult maxillary sinusitis as a cause of fever in tetraplegia: 2 case reports

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Brief report is presented to increase awareness of occult maxillary sinusitis as a potential cause of fever in recently injured patients with tetraplegia. Two cases are reported of patients with tetraplegic spinal cord injury who presented with fever of unknown origin. Common caused of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. After extensive work-up they were diagnosed with occult maxillary sinusitis. Patients with tetraplegia often undergo nasotracheal and nasogastric tube placement, which may result in mucosal irritation and nasal congestion. These factors, in combination with poor sinus drainage related to supine position, predispose them to developing maxillary sinusitis. Treatment options include removal of all nasal tubes, initiation of topical decongestants, and systemic antibiotic treatment.

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