Delirium, Diabetic Ketoacidosis, and ENT Symptoms: Your Dx?

Poll

This patient presents to the ED with delirium resulting from diabetic ketoacidosis. She also has a variety of ENT complaints, including recent bloody nasal discharge and confusion. Read the details of this case and see if you can make the diagnosis.

 

A 67-year-old woman with type 2 diabetes mellitus presented to the emergency department with delirium resulting from diabetic ketoacidosis. She also complained of headache, facial pain, nasal congestion, left eye pain, and blurry vision of 2 weeks’ duration. She noted recent bloody nasal discharge and confusion. The CT scan shown here of the patient’s sinus showed ethmoidal sinus congestion with air-fluid levels in the sphenoidal sinuses. Maxillary sinuses and turbinates appeared thickened, and there was left supraorbital soft tissue swelling. Histopathology using Gomori methenamine-silver nitrate stain is shown here.

What is your impression?

A. Rhinosinusitis
B. Acute bacterial sinusitis
C. Allergic rhinitis
D. Nasal polyps or tumor
E. Meningitis
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