title: Occult maxillary sinusitis as a cause of fever in tetraplegia: 2 case reports.
abstract: Common causes of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. We report 2 acute tetraplegic patients who presented with fever of unknown origin. After extensive work-up, they were diagnosed with occult maxillary sinusitis. A search of current literature revealed no reports of sinusitis as a potential source of fever in recently spinal cord--injured patients. Patients with tetraplegia, especially in the acute phase of spinal cord injury, often undergo nasotracheal intubation or nasogastric tube placement, which may result in mucosal irritation and nasal congestion. All of the previously mentioned factors, in combination with poor sinus drainage related to supine position, predispose them to developing maxillary sinusitis. The 2 consecutive cases show the importance of occult sinusitis in the differential diagnosis of fever in patients with tetraplegia.
authors.affiliation: Physical Medicine and Rehabilitation Service, Stanford University School of Medicine/VA Palo Alto Health Care System, 3901 Miranda Avenue, Palo Alto, CA 94304, USA. henrylew@roses.stanford.edu
authors.forename: Henry L
authors.initials: HL
authors.lastname: Lew
authors.forename: Jay
authors.initials: J
authors.lastname: Han
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Robinson
authors.forename: Catherine
authors.initials: C
authors.lastname: Britell
authors.forename: Inder
authors.initials: I
authors.lastname: Perkash
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005334:Fever / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D015523:Maxillary Sinusitis / Q000150:complications* / Q000000981:diagnostic imaging; D011782:Quadriplegia / Q000150:complications / Q000534:rehabilitation*; D011859:Radiography
chemical_list: D000900:Anti-Bacterial Agents