Some of you with a lot of sinus infections in the family wanted more information about how a sinus infection ended up in a Tuesday-Saturday hospitalization, and that is something I am not sure I can answer well: we DON’T get a lot of sinus infections at our house, which makes it hard to compare a typical one to this one. I got a sinus infection a number of years ago, and when my teeth started hurting I went to the doctor, and she gave me an antibiotic and I took it, and the sinus infection went away, the end. So that’s not super helpful. But I can tell you some of the miscellaneous things doctors mentioned as if they were important, and maybe those will make more sense to those of you with more experience.
One key element in Edward’s case is his Crohn’s disease and the immunosuppressant medication he takes to manage it (Remicade). One of the doctors said that this can make him vulnerable to some of the weirder little bugs that the rest of us would fight off easily.
This might be why the first antibiotic didn’t work: the pediatrician was assuming it was a sinus infection from one of the usual culprits, but maybe it was a weird culprit. Many doctors asked about MRSA and other antibiotic-resistant infections, and whether anyone else in the family had dealt with one. (No.)
Is it helpful to know that the ER doctor said the CAT scan showed allllll of the sinuses were infected? I didn’t know there WERE “allllll”; if asked, I would have thought there was one sinus that stretched across the face, or maybe two sinuses, one on each side—something like that. But there are sinuses up all the way around the cheek/eye region, and all of them were involved. I don’t know whether that’s typical.
The ER doctor mentioned that one sinus region (he pointed near his own eyebrow) has a membrane divider, and that there was so much infection in there, the membrane was “bulging,” and there was concern about rupturing. That’s just so gross.
An ENT doctor said that all the little passages up there were very small (that is, Edward’s set of passages were unusually small), and very swollen, so the sinuses couldn’t drain.
There was a lot of concern about the possibility of an abscess—a walled-off area of infection. If I’m understanding everything correctly, they did find one or two of these.
There was a lot of concern about his eye possibly being infected. The area around one eye was swollen and a light reddish-purplish color. (At one point it was swollen almost shut: that was after we arrived at the children’s hospital but before surgery.) Apparently it is not unusual for sinus infections to cause a little puffiness, but this must have been more than typical, because everyone involved was very interested, and we had an ophthalmologist in our room at 8:30 at night; she brought a suitcase of equipment. If there HAD been eye involvement, he would have needed immediate surgery that very night. Two doctors (the ophthalmologist and an ENT doctor) had a rather heated discussion about it right there in the room, when she (the ophthalmologist) had determined there was no eye involvement, and he (the ENT doctor) questioned her judgement and wanted to do another CAT scan “just in case.”
Something they found during surgery was that the flesh of his cheek was disintegrating. I will tell you that freaked me right out. The surgeon acted like that was a normal thing to say. I asked if my child’s face was going to continue to disintegrate and he acted as if that was a funny question to ask, but SERIOUSLY IS HIS FACE GOING TO CONTINUE TO DISINTEGRATE, I DIDN’T REALIZE IT COULD START TO DISINTEGRATE.
Cheek disintegration suggested to the doctors that this could be a fungal infection rather than a bacterial one; fungal infections are apparently another thing that can happen with immunosuppressing medication. They cultured everything, but didn’t get any decisive answers: one doctor mentioned they’d found some bacteria, but later more than one doctor mentioned finding no bacteria and no fungus. At first I thought that was a good thing (LESS bacteria/fungus in my child’s face) but it’s not exactly good: if they don’t find what it is, they don’t KNOW what it is, and that can make it harder to treat.
One of Paul’s co-workers gets a lot of sinus infections, and she was interested in the antibiotics, so I’ll put that here. The first doctor gave him cefuroxime, also called Ceftin; that’s the one that didn’t work. I don’t know what exactly he got by IV: he got a dose of something in the ER, and then they put him on two different IV antibiotics in the hospital; after a day or two, they took him off the one that was for antibiotic-resistant bacteria, because they felt that was not as likely to be the situation. They sent him home with cefpodoxime, which they said was fairly equivalent to the other of the IV antibiotics.
If you have any questions, like about things that I might not have thought to compare to regular sinus infections, I can attempt to answer those too.