title: Nocardia nova sphenoid sinusitis and infratemporal fossa abscess.
abstract: BACKGROUND
  Nocardia sinusitis is exceptional, as a Medline search revealed only one published case. The authors report a case of sphenoid sinusitis complicated by infratemporal fossa abscess, which raised several diagnostic problems.
  
  
  METHODS
  The patient was referred with temporal headache, subacute trigeminal neuralgia and subsequent infectious syndrome. Computed tomography imaging revealed left sphenoid sinusitis with osteolysis and infratemporal fossa abscess, as well as suspicious lung nodules suggestive of the initial site of infection. Bacteriological specimens obtained by endoscopic sphenoidotomy confirmed the presence of Nocardia nova. A favourable outcome was observed in response to targeted antibiotic therapy.
  
  
  CONCLUSIONS
  Sphenoid sinusitis with infratemporal fossa abscess is an exceptional mode of presentation of nocardiosis, illustrating the polymorphic clinical features of this disease. Bacteriological examination of samples taken directly from the organ concerned, in this case, by sphenoidotomy, is the only formal diagnostic criterion. Antibiotic therapy with intravenous imipenem/amikacin, followed by oral sulfamethoxazole/trimethoprim (Bactrim Forte(®)) for several months, is the key to successful management.
authors.affiliation: Service ORL et chirurgie cervico-faciale et plastique de la face, hôpital de la Miséricorde, 20303 Ajaccio cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Service ORL et chirurgie cervico-faciale et plastique de la face, hôpital de la Miséricorde, 20303 Ajaccio cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Cohen-Salmon
authors.affiliation: Service ORL et chirurgie cervico-faciale et plastique de la face, hôpital de la Miséricorde, 20303 Ajaccio cedex, France. Electronic address: Bertrand.joly@ch-ajaccio.fr.
authors.forename: B
authors.initials: B
authors.lastname: Joly
authors.affiliation: Service ORL et chirurgie cervico-faciale et plastique de la face, hôpital de la Miséricorde, 20303 Ajaccio cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Maffiolo
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging; D000368:Aged; D005260:Female; D006801:Humans; D009617:Nocardia Infections / Q000000981:diagnostic imaging; D015524:Sphenoid Sinusitis / Q000000981:diagnostic imaging / Q000382:microbiology*
keywords: Headache; Meningeal abscess; Nocardia; Sphenoid sinusitis