# Unilateral Palpebral Edema as a Central Sign of Acute Enterobacter-Associated Rhinosinusitis in a 5-Year-Old: A Rare Pediatric Case

## TL;DR

A 5-year-old child with rare Enterobacter-caused acute rhinosinusitis showed unusual symptoms and required surgery for effective treatment.

## Contribution

Highlights Enterobacter spp. as a rare cause of acute pediatric rhinosinusitis and the need for early surgical intervention.

## Key findings

- Enterobacter spp. was identified as the causative agent in a child with atypical acute rhinosinusitis symptoms.
- Standard antibiotic therapy failed, necessitating endoscopic sinus surgery for resolution.
- Early surgical intervention and culture-based treatment improved clinical outcomes.

## Abstract

Background and Clinical Significance: Acute pediatric rhinosinusitis is most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The involvement of Enterobacter species is rare and typically linked to chronic or nosocomial infections. Typical cases of acute rhinosinusitis in children present with abundant nasal discharge, headache, and fever and are generally managed with systemic antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), mucolytics, and topical intranasal treatment. Atypical presentations prompt heightened clinical attention, and depending on the symptoms and patient status, surgical interventions might be considered. Case Presentation: We report the case of a previously healthy 5-year-old boy presenting with painful unilateral palpebral edema, minimal ipsilateral nasal discharge, and persistent headache despite standard rhinosinusitis therapy. Imaging tests revealed complete right maxillary sinus opacification. As the clinical response to ceftriaxone and dexamethasone was minimal, we opted for endoscopic sinus surgery. A nasal swab culture identified Enterobacter spp. in the nasal discharge. Conclusions: Unusual pathogens like Enterobacter spp. can cause acute sinusitis in children without prior risk factors. Early surgical intervention and culture-adjusted antimicrobial therapy remain critical for favorable outcomes.