Nasal granulomatosis: diagnosis anda management
DOI:
https://doi.org/10.11606/issn.1679-9836.v102i4e-204043Keywords:
Granulmatoses, Etiologies, Diagnostic Flowchart, Nasal InflammationsAbstract
Introduction: Nasal granulomatosis are granulomatous inflammation of the tissues of the nose and paranasal sinuses that have high destructive power. They are generated by trauma, inflammation, infection, autoimmune reaction, neoplasia, substance abuse conditions or tics.
Objective: To analyze, in order to present an epidemiological profile, clinical characteristics, diagnostic criteria and treatment for four extraordinary etiologies of nasal and/or sinus granulomatosis (GEPA, tuberculosis, histoplasmosis and leishmaniasis) and, based on care protocols, present a guiding flowchart diagnosis and management of nasal granulomatosis.
Case reports: Four patients seen from February 2019 to February 2022, diagnosed with nasal granulomatosis and treated by the Otorhinolaryngology service of Hospital Santa Marcelina de Itaquera, São Paulo/SP, Brazil, one case of eosinophilic granulomatosis with polyangiitis (GEPA), one for tuberculosis, one for histoplasmosis and one for leishmaniasis.
Conclusion: Although not frequent, nasal granulomatosis generate a lot of morbidity for patients, therefore, they should be diagnosed and treated as soon as possible. As there are several causes for nasal granulomatosis and several complementary exams, the formulation of a diagnostic flowchart helps in this purpose.
Downloads
References
Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Tratado de Otorrinolaringologia e Cirurgia Cervicofacial da ABORL-CCF. 3ª. ed. São Paulo: ABORL-CCF; 2017
Fuchs HA, Tanner SB. Granulomatous disorders of the nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg. 2009;17(1):23-7. Doi: https//doi.org/10.1097/MOO.0b013e32831b9e58
Scadding GK, Durham SR, Mirakian R, Jones NS, Drake-Lee AB, Ryan D et al. British Society for Allergy and Clinical Immunology. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy. 2008;38(2):260-75. Doi: https://doi.org/10.1111/j.1365-2222.2007.02889.x
Furuta S, Iwamoto T, Nakajima H. Update on eosinophilic granulomatosis with polyangiitis. Allergol Int. 2019;68(4):430-6. Doi: https://doi.org/10.1016/j.alit.2019.06.004
Grayson PC, Ponte C, Suppiah R, Robson JC, Craven A, Judge A, et al. DCVAS Study Group. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis. Ann Rheum Dis. 2022;81(3):309-14. Doi: https://doi.org/10.1136/annrheumdis-2021-221794
Darouassi Y, Aljalil A, Hanine A, Enneouali A, Bouaity B, Touati MM, Ammar H. Nasopharyngeal tuberculosis: report of four cases and review of the literature. Pan Afr Med J. 2019;33:150. Doi: https://doi.org/10.11604/pamj.2019.33.150.15892
Oda N, Koyama T, Ikeda G, Takata I. Nasopharyngeal tuberculosis detected on imaging. BMJ Case Rep. 2021;14(8):e245736. Doi: https://doi.org/10.1136/bcr-2021-245736
Sarwar F, Sheikh S, Khan NU, Fatima SN. Tubercular septal abscess in a postoperative patient: a novel entity. BMJ Case Rep. 2018;bcr2018224892. Doi: https://doi.org/10.1136/bcr-2018-224892
Ahmed S, Mustahsan SM, Jamil B, Ilyas F. Nasopharyngeal Tuberculosis. J Coll Physicians Surg Pak. 2022;32(4):S39-S40. Doi: https://doi.org/10.29271/jcpsp.2022.Supp1.S39
Yang Y, Fang Y, Yang G. Nasopharyngeal tuberculosis: a case report. Open Life Sci. 2022;17(1):973-7.Doi: https://doi.org/10.1515/biol-2022-0077
Misirovs R, Johnston L, Green R. Primary nasopharyngeal tuberculosis. BMJ Case Rep. 2022;15(12):e251927. Doi: https://doi.org/10.1136/bcr-2022-251927
Pais JP, Caçador M, Mourato T, Paço J. Chronic nasopharyngeal and otitis media tuberculosis: diagnosis and management difficulties. BMJ Case Rep. 2022;15(8):e250690. Doi: https://doi.org/10.1136/bcr-2022-250690
Min HJ, Kim KS. Primary nasopharyngeal tuberculosis: a case report focused on nasopharyngoscopic features and CT Findings. Ear Nose Throat J. 2021;100(10_suppl):949S-52S. Doi: https://doi.org/10.1177/0145561320931951
Penjor D, Pradhan B. Diagnostic dilemma in a patient with nasopharyngeal tuberculosis: A case report and literature review. SAGE Open Med Case Rep. 2022;10:2050313X221131389. Doi: https://doi.org/10.1177/2050313X221131389
Aggarwal N, Dutta M, Sinha R. Primary tuberculosis of the nasal septum: The non-ulcerated form presenting as septal thickening. Acta Otorrinolaringol Esp (Engl Ed). 2018;69(4):243-5. Doi: https://doi.org/10.1016/j.otorri.2017.05.004
Ahmed S, Mustahsan SM, Jamil B, Ilyas F. Nasopharyngeal tuberculosis. JCPSP. 2022;32(4):S39-S40. Doi: https://doi.org/10.29271/jcpsp.2022.supp1.s39
Xiao K, Si Y, Zhong L. Letter to the Editor: Primary Nasal Tuberculosis in a Human Immunodeficiency Virus-Infected Patient. Surg Infect (Larchmt). 2022;23(6):610-1. Doi: https://doi.org/10.1089/sur.2022.129
O'Connell Ferster AP, Jaworek A, Hu A. Histoplasmosis of the head and neck in the immunocompetent patient: Report of 2 cases. Ear Nose Throat J. 2018;97(9):E28-E31. PMID: 30273439.
Escalante L, Granizo-Rubio J, Pinos-León V, Tello S, Maldonado A, Cherrez-Ojeda I. Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. BMC Infect Dis. 2022;22(1):377. Doi: https://doi.org/10.1186/s12879-022-07351-0
Singh A, Gauri M, Gautam P, Gautam D, Haq M, Handa AC, et al. Head and neck involvement with histoplasmosis; the great masquerader. Am J Otolaryngol. 2019;40(5):678-83. Doi: https://doi.org/10.1016/j.amjoto.2019.06.002
Pineda J, Merino-Alado R, Mata-Essayag S, Landaeta ME, Garrido L, Rosas M del M. Nasal Septum Perforation Associated to Histoplasmosis: A Retrospective Study. Pesqui Bras Odontopediatria Clín Integr. 2020;20:e5470. Doi: https://doi.org/10.1590/pboci.2020.090
Roca B, Roca M. Mucocutaneous leishmaniasis (espundia). Postgrad Med J. 2020;96(1142):789. Doi: https://doi.org/10.1136/postgradmedj-2019-137465
Sánchez-Romero C, Júnior HM, Matta VLRD, Freitas LM, Soares CM, Mariano FV, et al. Immunohistochemical and molecular diagnosis of mucocutaneous and mucosal Leishmaniasis. Int J Surg Pathol. 2020;28(2):138-45. Doi: https://doi.org/10.1177/1066896919876706
Rojas-Jaimes J, Frischtak HL, Arenas J, Lescano AG. Case Report: mucosal Leishmaniasis presenting with nasal septum perforation after almost thirty years. Am J Trop Med Hyg. 2018;99(2):327-30. Doi: https://doi.org/10.4269/ajtmh.17-0831
Sbroglio LL, Maiolini VM, Rabelo IMMA, Giraldelli GA, Tuccori LP, Cunha RG. Mucocutaneous leishmaniasis in a cocaine user: diagnostic and therapeutic knowledge. Rev Soc Bras Med Trop. 2020;53:e20200040. Doi: https://doi.org/10.1590/0037-8682-0040-2020
Suqati AA, Pudszuhn A, Hofmann VM. Mucocutaneous leishmaniasis: case report and literature review of a rare endonasal infection. Pan Afr Med J. 2020;36:292. Doi: https://doi.org/10.11604/pamj.2020.36.292.24543
Muvdi-Arenas S, Ovalle-Bracho C. Mucosal leishmaniasis: A forgotten disease, description and identification of species in 50 Colombian cases. Biomedica. 2019;39(Supl. 2):58-65. English, Spanish. Doi: https://doi.org/10.7705/biomedica.v39i3.4347
Bezemer JM, Meesters K, Naveda CL, Machado PRL, Calvopiña M, Leeflang MMG, et al. Clinical criteria for mucosal leishmaniasis diagnosis in rural South America: a systematic literature review. PLoS Negl Trop Dis. 2022;16(8):e0010621. Doi: https://doi.org/10.1371/journal.pntd.0010621
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Mariana Ignacio Gomes, Eliane Maria Dias von Söhsten Lins , Marcela Giorisatto Dutra, Mariana Aguiar Bianco de Abreu, Carlos Eduardo Cesário de Abreu, Edson Monteiro
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
