Cerebral venous thrombosis and bilateral ophthalmoplegia complicating sphenoid sinusitis: a case report.

Sphenoid sinusitis is a rare form of sinusitis characterized by inflammation of the sphenoid sinuses, located deep within the skull. Despite its rarity, sphenoid sinusitis can lead to significant morbidity due to its proximity to critical anatomical structures, including the optic nerves and the cavernous sinuses. Clinical presentations may range from non-specific symptoms such as headaches and facial pain to more severe manifestations like visual disturbances or cranial nerve palsies. Diagnosis typically involves a combination of clinical evaluation, imaging studies (such as computed tomography or magnetic resonance imaging), and frequently endoscopic examination for tissue sampling and debridement. Management strategies may include antibiotics for bacterial infections, corticosteroids for inflammation, and, in refractory cases, surgical intervention to enhance drainage and address underlying anatomical issues. Given the potential for serious complications, timely diagnosis and appropriate treatment are crucial for favorable outcomes in patients with sphenoid sinusitis. We present a case of severe sphenoid sinusitis in an immunocompromised patient receiving combination immunosuppressive therapy for rheumatoid arthritis, complicated by internal jugular vein and cerebral sigmoid sinus thrombosis. The causative organism was methicillin-sensitive Staphylococcus aureus and patient was discharged on anticoagulation with apixaban and a 6-week course of intravenous Cefazolin.