Delayed Presentation of Nasal Septal Abscess in a Pediatric Patient Following Infectious Mononucleosis and Acute Bacterial Sinusitis

Introduction: The clinical presentation of infectious mononucleosis includes several head and neck manifestations, but does not commonly include sinonasal manifestations. In addition, it is rare for a nasal septal abscess to develop as sequelae of sinusitis. We report a unique case where a pediatric patient developed acute bacterial sinusitis and a nasal septal abscess following an episode of infectious mononucleosis. This is the first reported case of infectious mononucleosis resulting in complicated acute sinusitis with nasal septal abscess. Case presentation: A 16-year-old otherwise healthy Caucasian female presented with infectious mononucleosis and subsequently developed acute bacterial sinusitis. She then developed persistent nasal pain, nasal obstruction, and on exam was found to have bilateral septal fullness with nasal obstruction consistent with a nasal septal abscess. Emergent surgical intervention to drain the abscess followed by systemic antibiotics and delayed reconstructive rhinoplasty. Conclusion: This case shows that even in the absence of trauma, nasal septal abscess must be considered in patients presenting with persistent nasal pain, obstruction and congestion. This is important for primary care providers, emergency medicine physicians and other health care professionals triaging patients with this constellation of symptoms so that prompt referral may be made to a specialist forappropriate care. This case also suggests that infectious mononucleosis can leave a patient more susceptible to bacterial super infection via inflammatory immune modulation.