Enterococcus faecalis as an uncommon pathogen in acute rhinosinusitis: a case report with surgical management

Introduction. Acute bacterial sinusitis in immuno­com­pe­tent adults is typically caused by Streptococcus pneumoniae, Hae­mo­phi­lus influenzae and Moraxella catarrhalis. En­te­ro­co­ccus faecalis is a rare etiologic agent in sinonasal in­fec­tions, being usually linked to nosocomial settings, im­mu­no­sup­pres­sion or chronic disease. Case presentation. We present the case of a previously healthy 27-year-old man with acute exacerbation of chronic rhinosinusitis, pre­sen­ting with severe unilateral head­ache, palpebral ne­cro­sis and purulent nasal discharge. The patient was ma­naged with broad-spectrum intravenous anti­bio­tics and under­went combined endoscopic sinus surgery and external fron­tal sinus drainage (modified Ogston-Luc pro­ce­dure). Cul­ture of the collected material identified En­te­ro­coc­cus fae­ca­lis as the primary pathogen. Discussion. This case high­lights an unusual presentation of acute complicated si­nu­si­tis caused by Enterococcus faecalis in an otherwise healthy young adult. While rarely implicated in community-ac­qui­red rhi­no­si­nu­sitis, its detection should prompt con­si­de­ra­tion of resistance mechanisms, biofilm formation and sub­opti­mal hygie­nic factors. Early surgical intervention and microbiological identification were essential in guiding the effective antibiotic therapy. Conclusions. Enterococcus fae­ca­lis may represent an emerging, atypical pathogen in sinus in­fec­tions even in low-risk individuals. Accurate diagnosis, prompt surgical management and culture-directed therapy are critical in avoiding com­pli­ca­tions and ensuring optimal cli­ni­cal outcomes.