Atrophic rhinitis is characterized by progressive nasal mucosal atrophy, nasal crusting, fetor, and enlargement of the nasal space with paradoxical nasal congestion. Among diseases responsible of secondary atrophic rhinitis, infective- and noninfective-granulomatous and autoimmune diseases may be advocated, even if they represent less than 1% of etiologies. This group of pathologies should be considered especially in patients without medical history of nasal surgery or radiation and in presence of systemic symptoms, such as low-grade fever, weight loss, and arthralgias. The most frequent autoimmune diseases resulting in atrophic rhinitis are granulomatosis with polyangiitis, sarcoidosis, and mucous membrane pemphigoid [1]. Among granulomatous infections, tuberculosis and syphilis are the leading reported causes of this group of rhinosinusitis [1]. An accurate anamnesis may highlight current or past unexplained skin lesions, arthritis, shortness of breath, or neurologic symptoms. In addition, history of travel in foreign countries and sexual promiscuity should be checked. Routine laboratory tests may underline high ESR and CRP values, anemia, and renal abnormalities, such as unexplained renal failure, proteinuria, and red cell casts. All patients with secondary atrophic rhinitis should undergo a Chest X-ray to rule out lung infiltrations or cavities and mediastinal lymphadenopathies. Presence of ANCA antibodies and QuantiFERON TB-test positivity should be checked; in presence of a suggestive history also VDRL, TPHA and HIV-test may be considered. A nasal biopsy aimed to perform histology and microbiological tests is usually required to confirm the diagnosis.
Gigante, L., Zoli, A., Giacomini, P.g., Zoli, A. (2020). Secondary Atrophic Rhinitis: Autoimmune and Granulomatous Forms. In Stefano Di Girolamo Editor (a cura di), Atrophic Rhinitis From the Voluptuary Nasal Pathology to the Empty Nose Syndrome, ISBN 978-3-030-51704-5 ISBN 978-3-030-51705-2 (eBook) https://doi.org/10.1007/978-3-030-51705-2 © Springer Nature Switzerland AG 2020 (pp. 13-30). © Springer Nature Switzerland AG [10.1007/978-3-030-51705-2_2].
Secondary Atrophic Rhinitis: Autoimmune and Granulomatous Forms
Giacomini, Pier Giorgio;
2020-01-01
Abstract
Atrophic rhinitis is characterized by progressive nasal mucosal atrophy, nasal crusting, fetor, and enlargement of the nasal space with paradoxical nasal congestion. Among diseases responsible of secondary atrophic rhinitis, infective- and noninfective-granulomatous and autoimmune diseases may be advocated, even if they represent less than 1% of etiologies. This group of pathologies should be considered especially in patients without medical history of nasal surgery or radiation and in presence of systemic symptoms, such as low-grade fever, weight loss, and arthralgias. The most frequent autoimmune diseases resulting in atrophic rhinitis are granulomatosis with polyangiitis, sarcoidosis, and mucous membrane pemphigoid [1]. Among granulomatous infections, tuberculosis and syphilis are the leading reported causes of this group of rhinosinusitis [1]. An accurate anamnesis may highlight current or past unexplained skin lesions, arthritis, shortness of breath, or neurologic symptoms. In addition, history of travel in foreign countries and sexual promiscuity should be checked. Routine laboratory tests may underline high ESR and CRP values, anemia, and renal abnormalities, such as unexplained renal failure, proteinuria, and red cell casts. All patients with secondary atrophic rhinitis should undergo a Chest X-ray to rule out lung infiltrations or cavities and mediastinal lymphadenopathies. Presence of ANCA antibodies and QuantiFERON TB-test positivity should be checked; in presence of a suggestive history also VDRL, TPHA and HIV-test may be considered. A nasal biopsy aimed to perform histology and microbiological tests is usually required to confirm the diagnosis.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
