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JAMA Clinical Challenge | Clinician's Corner

Antibiotic-Refractory Sinusitis

Javier Munoz, MD; Philip Kuriakose, MD
JAMA. 2012;308(22):2399-2400. doi:10.1001/jama.2012.91077.
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A 64-year-old man with a history of chronic sinusitis presents withleft periorbital swelling and subtle left ptosis (Figure 1). His past medical history is otherwise unremarkable. He was treated with amoxicillin-clavulanate, 875 mg/125 mg, twice per day for 10 days for presumed sinusitis. He experienced mild temporary improvement. Symptoms recurred within a month, and he was given a second course of amoxicillin. Physical examination reveals worsening left periorbital swelling, unilateral nasal blockade, and persistent subtle left ptosis. The neurological examination results are normal, and ptosis is thought to be secondary to palpebral swelling. Lymphadenopathy and hepatosplenomegaly are absent. Laboratory test results are unremarkable.

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Figure 1. Left periorbital swelling and subtle left ptosis that was initially presumed to be sinusitis.
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Figure 2. Computed tomography showing a mass extending into the left ethmoid and frontal sinuses.
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Figure 3. Histology showing medium to large cells with round to oval nuclei and a moderate amount of cytoplasm, compatible with a diagnosis of diffuse large B-cell lymphoma (hematoxylin-eosin, original magnification ×200).
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