Differential Diagnosis for Burning Pain around Maxillary Right Sinus

After completing antibiotics for a bacterial sinus infection caused by Klebsiella oxytoca, the patient experiences sudden burning pain around the maxillary right sinus without colored mucus or phlegm. The following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Rebound Sinusitis or Persistent Sinusitis: This could be due to incomplete eradication of the infection, development of antibiotic resistance, or rebound congestion and inflammation after stopping the antibiotics. The burning pain could be indicative of ongoing sinus inflammation.

• Other Likely Diagnoses

  • Sinus Headache: Often associated with sinusitis, but can also occur independently. The pain can be sharp, dull, or burning and is usually localized to the area of the affected sinus.
  • Trigeminal Neuralgia: A condition that affects the trigeminal nerve, which can cause intense, shock-like or burning pain in parts of the face, including the area around the maxillary sinus.
  • Dental Issues: Problems such as an abscess, impacted tooth, or gum disease can refer pain to the maxillary sinus area, feeling like sinus pain.

• Do Not Miss Diagnoses

  • Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that can occur as a complication of sinusitis. It presents with severe headache, fever, and possibly neurological deficits.
  • Mucormycosis (Black Fungus): An opportunistic fungal infection that can invade the sinuses, especially in immunocompromised patients. It's crucial to consider this in patients with uncontrolled diabetes, on immunosuppressive therapy, or with a history of prolonged antibiotic use.
  • Osteomyelitis of the Maxilla: A bone infection that can cause severe pain and is a complication of sinusitis or dental infections.

• Rare Diagnoses

  • Sphenoid Sinusitis: Infection of the sphenoid sinus, which is less common but can cause severe headache and facial pain.
  • Tolosa-Hunt Syndrome: A rare disorder characterized by severe and unilateral headaches with extraocular palsies, which can mimic sinusitis pain.
  • Neoplastic Lesions: Tumors in the sinus or surrounding structures can cause pain and should be considered in the differential diagnosis, especially if there are other symptoms like nasal obstruction or bleeding.