Nasal septal perforation and antiphospholipid syndrome (Hughes syndrome)

Autoimmune-related nasal septum perforation: A case report and systematic review

Background:

Inflammatory injury of nasal respiratory mucosa is a common feature of multisystem autoimmune disease. Certain autoimmune disorders are associated with nasal septum perforation (NSP). We performed a systematic review of the literature to better understand the association of NSP with specific autoimmune disorders. This is a case report of a 29-year-old woman with a history of arthralgia, autoreactive antibody titers, platelet dysfunction, and NSP. The constellation of symptoms and potential familial involvement indicated that the NSP in this patient was an early sign of an autoimmune disorder, an unknown autoimmune disorder, or a known disease with incomplete penetrance.

Methods:

A systematic review of the literature was performed by two independent reviewers. Relevant articles were reviewed, and data that pertained to autoimmune-related NSP were extracted and analyzed.

Results:

Overall, 140 cases of autoimmune-associated NSPs were reported. Granulomatosis with polyangiitis (48%), relapsing polychondritis (26%), and cocaine-induced midline lesions (15%) constituted 89.3% of the reported cases.

Conclusion:

NSP is a potential sign of systemic disease. The identification of an NSP, especially in the context of other unexplained symptoms or workup suggestive of an autoimmune disorder, should prompt clinical evaluation for multisystem autoimmune disease with consideration of granulomatosis with polyangiitis, relapsing polychondritis, or cocaine-induced midline lesions.

12 minute consultation: a patient with nasal crusting

BACKGROUND

Nasal crusting is frequently encountered by the otorhinolaryngologist and often requires no specific treatment. It is, however, important to carry out a full history and examination, followed by appropriate investigations, in order to detect the small number of cases in which crusting is caused by systemic or malignant disease.

METHODS

This review was based on a literature search last performed on 30th July 2009. The MEDLINE, EMBASE and Cochrane databases were searched using the subject headings (nasal crusting OR crusts) and in combination with diagnosis, therapy and surgery. Similar searches were performed for relevant diseases, e.g. Wegener's granulomatosis, sarcoidosis. Results were limited to English language articles including clinical trials, meta-analyses, systematic reviews and review articles. Relevant references from selected articles were reviewed.

RESULTS

Knowledge of the causes of nasal crusting will help to target the history, examination and investigation of patients with this condition. Screening tests for systemic conditions can be useful but most have limited sensitivity and must be interpreted cautiously. Nasal septal biopsy is indicated when there is a suspicion of malignancy, or to support a suspected diagnosis of vasculitis. The treatment offered depends upon the cause of crusting and the severity of symptoms.

CONCLUSION

A careful and thorough history and examination, and targeted investigation, of the patient with nasal crusting will ensure correct diagnosis and treatment of patients with this common condition.

Nasal septal perforation in a patient with Takayasu's arteritis; a rare association

Takayasu's arteritis (TA) is a chronic, progressive, granulomatous inflammation of the aorta and its major branches, and is diagnosed often only in the late stage. The late phase of disease is characterized by variety of ischemic symptoms due to stenosis or occlusion of the major arteries. Although major neurological events such as stroke, transient ischemic attacks, and seizures due to either progressive arterial stenosis or hypertension, are reported to occur in one-fifth of the patients, nasal septal perforation has not been previously reported. Herein we present a young woman with TA who was hospitalized with left hemiparesis due to occlusion of stented carotid artery. Her clinical course was also complicated with nasal septal perforation. This case suggested that nasal septal perforation could be a rare complication of TA and might be considered as a part of the clinical spectrum of the disease.