Chronic rhinosinusitis with bone destruction in a teenager with cystic fibrosis

  • João Rio Martins Pediatric Cystic Fibrosis Center, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra
  • João Fonseca Neves Department of Otorhinolaryngology, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra
  • Teresa Reis Silva Pediatric Cystic Fibrosis Center, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra
  • Miguel Félix Pediatric Cystic Fibrosis Center, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra
Keywords: bone destruction, chronic rhinosinusitis, cystic fibrosis, endoscopic sinus surgery, methicillin-resistant Staphylococcus aureus

Abstract

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.

References

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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.

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Published
2019-07-18
Section
Case Reports