Chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis: clinical presentation and antineutrophil cytoplasmic antibodies

Abstract

Background In this study we aim to describe presenting characteristics and identify prognostic factors for disease resolution in patients with chronic rhinosinusitis (CRS) in the setting of eosinophilic granulomatosis with polyangiitis (EGPA). Methods Patients evaluated at a tertiary care center with diagnoses of EGPA and CRS were identified. Descriptive statistics were obtained. Univariate analysis was used to search for prognostic factors associated with higher Lund‐Mackay score at presentation and disease resolution. Results Forty‐four patients were included with a mean age of 52.7 (standard deviation, 14) years. Twenty‐one patients (47.7%) were female, all had a diagnosis of asthma, and 36 (83.7%) had eosinophils >10%. Common presenting symptoms for CRS included nasal discharge (87.9%) followed by nasal congestion (83.9%) and facial pain and pressure (83.8%). Medical management of CRS included systemic corticosteroids (93.2%) and systemic antibiotics (75%). Surgical intervention occurred in 29 patients (67%). Nine patients (20.5%) had resolution of sinus symptoms, including 4 with imaging confirmation. Fourteen patients (31.8%) had continued CRS, but with improved symptoms, whereas 9 patients (20.5%) had continued CRS with no improvement in symptoms. Eleven patients (25%) were lost to follow‐up and 4 (9.1%) died. Univariate analysis did not show antineutrophil cytoplasmic antibody positivity, presence of peripheral eosinophilia, gender, age, or absence of systemic therapy to be predictive of higher Lund‐Mackay score at presentation or predictive of disease resolution. Conclusion CRS in patients with EGPA is often refractory to medical and surgical management. Treatment of these patients should occur in a multidisciplinary setting.

Elevated Urine LeukotrieneE4Is Associated With Worse Objective Markers in Nasal Polyposis Patients

“…The ideal disease biomarker is easily obtainable and must have high predictive value for the disease in question 32‐36 . To this end, uLTE4 has proved valuable in helping to differentiate aspirin‐tolerant CRSwNP patients from AERD patients 12,15,37 .…”

Eosinophile Granulomatose mit Polyangiitis – ein Übersichtsartikel

“…Beim Auftreten von Hämoptysen muss an eine alveoläre Hämorrhagie gedacht werden. Diese tritt allerdings bei der EGPA seltener auf als bei den anderen AAV und ist mit positiven ANCA assoziiert [3,15]. Alle EGPA-Patienten sollten eine lungenfunktionelle Untersuchung mit Erfassung der Diffusionskapazität erhalten.…”

Urine Leukotriene E4: Implications as a Biomarker in Chronic Rhinosinusitis

“…Although historically considered a single disease entity, CRS is more accurately characterized as a number of related but distinct disease endotypes 5-10 ( Figure 1 ). Initial simplistic designations of CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP) have been described for many years.…”

“…1,4 Commonly defined as 12 weeks or longer of subjective symptoms and objective evidence of paranasal sinus inflammation, CRS is classically associated with cardinal symptoms, including nasal obstruction, hyposmia, mucopurulent drainage, and facial pressure. 4 Although historically considered a single disease entity, CRS is more accurately characterized as a number of related but distinct disease endotypes [5][6][7][8][9][10] (Figure 1). Initial simplistic designations of CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP) have been described for many years.…”