An uncommon common cold

This is a magnetic resonance image of the head of a previously well teenager with a one month history of nasal congestion and coryzal symptoms who developed severe headache and recurrent high fever (fig 1). He had no history of surgery or trauma. The image shows an acute frontal sinusitis (white arrow), epidural abscess (arrowhead), and frontal lobe abscess (white dotted arrow). Next generation sequencing of blood and cerebrospinal fluid samples identified Mycoplasma salivarium as the likely causative agent.bmj;385/may09_4/e079326/F1F1f1Fig 1As a history of trauma or surgery was lacking, this infection likely spread through either congenital bone defects or sutures in the cribriform plate, ethmoid sinus roof, or posterior wall of the frontal sinus. These sutures allow close contact between the mucosa and dura.1 Other possible transmission routes include mucosal veins in the frontal sinus via septic emboli, or lymphatic pathways.2 This patient underwent an emergency endoscopic frontal sinusotomy to drain…
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