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Sinusitis Mimics: ED-relevant pearls and pitfalls

Your next patient is a 17-year-old male you had seen one week before for fever and congestion, diagnosed with a viral upper respiratory infection.  He returns this time for nasal congestion, severe frontal headache, fevers, sore throat, and nasal drainage.  When he looks around the room, he gets dizzy and is seeing double.   He is febrile, tachycardic, and ill appearing, and you note proptosis of the right eye, a sluggish pupil, and inability to move the eye due to pain. Is this sinusitis, or something more sinister?