Chronic rhinosinusitis with bone destruction in a teenager with cystic fibrosis
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v28.i2.14853Keywords:
bone destruction, chronic rhinosinusitis, cystic fibrosis, endoscopic sinus surgery, methicillin-resistant Staphylococcus aureusAbstract
Introduction: Chronic rhinosinusitis (CRS) is almost invariably present in cystic fibrosis (CF) patients, with a detrimental impact in their quality of life. Functional endoscopic sinus surgery (FESS) has been proven effective when medical management approaches are exhausted.
Case Summary: A twelve-year-old female with CF and a several-month history of intermittent fever, recurrent cough, and purulent sputum despite intensive medical management was admitted due to fever and frontal headaches starting a few days after initiation of nocturnal non-invasive ventilation. Perinasal and cerebral sinuses’ computed tomography scan and magnetic resonance imaging showed a severe CRS complicated with bone destruction of the left frontal sinus and crista galli. Intravenous antibiotics and antifungal were started, and FESS was performed with significant clinical improvement. Microbiologic study was positive for methicillin-resistant Staphylococcus aureus.
Discussion: This case shows that regular assessment of sinusal disease in CF children is essential, especially in those with chronic infections. FESS may be usefull when medical management approaches are exhausted, effectively improving patients’s quality of life.
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References
2. Virgin FW. Clinical Chronic Rhinosinusitis Outcomes in Pediatric Patients with Cystic Fibrosis. Laryngoscope Investig Otolaryngol. 2017; 2:276–80.
3. Digoy GP, Dunn JD, Stoner JA, Christie A, Jones DT. Bacteriology of the paranasal sinuses in pediatric cystic fibrosis patients. International Journal of Pediatric Otorhinolaryngology 2012; 76:934-8.
4. Tumin D, Hayes Jr. D, Kirkby SE, Tobias JD, McKee C. Safety of endoscopic sinus surgery in children with cystic fibrosis. International Journal of Pediatric Otorhinolaryngology 2017; 98:25-8.
5. Liang J, Higgins TS, Ishman SL, Boss EF, Benke JR, Lin SY. Surgical management of chronic rhinosinusitis in cystic fibrosis: a systematic review. International Forum of Allergy & Rhinology 2013; 3:814-22.
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