This lady presented feeling generally unwell. Her symptoms included right-sided sinusitis - headaches/pressure which she stated felt like previous sinus headaches. She also reported right-sided nasal blockage and purulent nasal discharge (brown/green/blood-stained). Neurological examination was grossly normal and she reported no visual disturbance.

She developed sepsis and her admission was complicated by NSTEMI and APO. Treatment with antibiotics, dual antiplatelet and ACE inhibitors, beta-blockers and diuretics.

The diagnosis was right sphenoid sinusitis (possibly fungal and bacterial) with S. aureus bacteremia (likely source for superior ophthalmic vein thrombus).