Systemic Diseases and Chronic Rhinosinusitis

  • Christine Reger
  • Christina F. Herrera
  • Megan Abbott
  • Alexander G. Chiu

Many systemic diseases can cause nasal symptoms, either as an initial presentation or a manifestation later in the disease process. When patients present with nasal symptoms resembling infection—such as purulent nasal discharge, crusting, and congestion—acute rhinosinusitis is likely to be diagnosed. However, when these symptoms persist despite appropriate medical therapy, other etiologies should be considered. In some cases, underlying inflammation of the nasal mucosa causes recurrent or chronic sinusitis, as in nasal polyposis or allergic rhinitis. Less frequently, systemic rather than local conditions are the cause, requiring a more detailed evaluation, comprehensive systemic management, and long-term follow-up [1]. The number of systemic illnesses that can cause nasal symptoms is substantial; only those most commonly affecting the nose and sinuses are discussed here. For purposes of discussion, the diseases have been categorized as follows: autoimmune disorders, infectious...


Human Immunodeficiency Virus Systemic Lupus Erythematosus Cystic Fibrosis Cystic Fibrosis Patient Nasal Mucosa 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Tami TA. Granulomatous diseases and chronic rhinosinusitis. Otolaryngol Clin N Am 2005;38:1267–1278.CrossRefGoogle Scholar
  2. 2.
    Lloyd G, Lund VJ, Beale T, et al. Radiology in focus: rhinologic changes in Wegener’s granulomatosis. J Laryngol Otol 2002;116: 565–569.PubMedGoogle Scholar
  3. 3.
    Woywodt A, Haubitz M, Haller H, et al. Wegener’s granulomatosis. Lancet 2006;367: 1362–1366.PubMedCrossRefGoogle Scholar
  4. 4.
    Lagnese ME, Dhaliwal G. Case report: an initial diagnosis of Wegener’s granulomatosis in an 82-year-old woman. Hosp Phys 2007;52:33–36.Google Scholar
  5. 5.
    Leavitt RY, Fauci AS, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 1990;33:1101–1107.PubMedCrossRefGoogle Scholar
  6. 6.
    Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med 1997;337:1124–1234.CrossRefGoogle Scholar
  7. 7.
    Cox CE, Davis-Allen A, Judson MA. Sarcoidosis. Med Clin N Am 2005;89:817–828.PubMedCrossRefGoogle Scholar
  8. 8.
    Wang X, Kim J, McWilliams R, Cutting G. Increased prevalence of chronic rhinosinusitis in carriers of a cystic fibrosis mutation. Arch Otolaryngol Head Neck Surg 2005;131:237–240.PubMedCrossRefGoogle Scholar
  9. 9.
    Gilljam M, Ellis L, Corey M, Zielenski J, Durie P, Tullis E. Clinical manifestations of cystic fibrosis among patients with diagnosis in adulthood. Chest 2004;126:1215–1224.PubMedCrossRefGoogle Scholar
  10. 10.
    Jorissen M, De Boek K, Cuppens H. Genotype-phenotype correlations for the paranasal sinuses in cystic fibrosis. Am J Respir Crit Care Med 1999;159:1412–1416.PubMedGoogle Scholar
  11. 11.
    Young M, Gould J, Upton, G. Nasal polyposis in children with cystic fibrosis: a long-term follow-up study. Ann Otol Rhinol Laryngol 2002;111:1081–1086.Google Scholar
  12. 12.
    Rosenstein B, Cutting G. The diagnosis of cystic fibrosis: a consensus statement. J Pediatr 1998;132:589–595.PubMedCrossRefGoogle Scholar
  13. 13.
    Ratgen F, Doring G. Seminar: cystic fibrosis. Lancet 2003;361:681–689.CrossRefGoogle Scholar
  14. 14.
    Flume P, O’Sullivan B, Robinson K, et al. Cystic fibrosis pulmonary guidelines: chronic medications for maintenance of lung health. Am J Respir Crit Care Med 2007;176:957–969.PubMedCrossRefGoogle Scholar
  15. 15.
    Abril A, Calamia KT, Cohen MD. The Churg Strauss syndrome (allergic granulomatous angiitis): review and update. Semin Arthritis Rheum 2003;33:106–114.PubMedCrossRefGoogle Scholar
  16. 16.
    Pagnoux C, Gulpain P, Guillevin L. Churg-Strauss syndrome. Curr Opin Rheumatol 2007;19:25–32.PubMedCrossRefGoogle Scholar
  17. 17.
    Keogh KA, Specks U. Churg-Strauss syndrome. Semin Respir Crit Care Med 2006;27: 148–157.PubMedCrossRefGoogle Scholar
  18. 18.
    Rapini RP, Warner NB. Relapsing polychondritis. Clinics Dermatol 2006;24:482–485.CrossRefGoogle Scholar
  19. 19.
    Liu CM, Hata TR, Swinyer L, et al. Morphology: relapsing polychondritis. Int J Dermatol 2003;42:707–708.PubMedCrossRefGoogle Scholar
  20. 20.
    Kent PD, Michet CJ, Luthra HS, et al. Relapsing polychondritis. Curr Opin Rheumatol 2004;16:56–61.PubMedCrossRefGoogle Scholar
  21. 21.
    D’Cruz DP, Khamashta MA, Hughes GRV. Systemic lupus erythematosis. Lancet 2007;369:587–596.PubMedCrossRefGoogle Scholar
  22. 22.
    Rothfield N, Sontheimer R, Bernstein M. Lupus erythematosis: systemic and cutaneous manifestations. Clinics Dermatol 2006;24:348–362.CrossRefGoogle Scholar
  23. 23.
    Gungor A, Adusumilli V, Corey J. Fungal sinusitis: progression of disease in immunosuppression. Ear Nose Throat J 1998;77:207–212.PubMedGoogle Scholar
  24. 24.
    Mandava P, Chaljub G, Patterson K, et al. MR imaging of cavernous sinus invasion by mucormycosis: a case study. Clin Neurol Neurosurg 2001;103:101–104.PubMedCrossRefGoogle Scholar
  25. 25.
    Mylona S, Tzavara V, Ntai S, et al. Chronic invasive sinus aspergillosis in an immunocompetent patient: a case report. Dentomaxillofacial Radiol 2007;36:102–104.Google Scholar
  26. 26.
    Kauffman CA. Fungal infections. Proc Am Thorac Soc (PATS) 2006;3:35–40.CrossRefGoogle Scholar
  27. 27.
    Iwen PC, Rupp ME, Hinrichs SH. Invasive mold sinusitis: 17 cases in immunocompromised patients and review of the literature. Clin Infect Dis 1997;24:1178–1184.PubMedCrossRefGoogle Scholar
  28. 28.
    Goh BT. Syphilis in adults. Sex Transm Dis 2005;81:448–452.Google Scholar
  29. 29.
    Baughn RE, Musher DM. Secondary syphilitic lesions. Clin Microbiol Rev 2005;18: 205–216.PubMedCrossRefGoogle Scholar
  30. 30.
    Hamlyn E, Marriott D, Gallagher RM. Secondary syphilis presenting as tonsillitis in three patients. J Laryngol Otol 2006;120:602–604.PubMedCrossRefGoogle Scholar
  31. 31.
    Wallace RJ, Brown-Elliott BA, Hall L, et al. Clinical and laboratory features of Mycobacterium mageritense. J Clin Microbiol 2002;40:2930–2935.PubMedCrossRefGoogle Scholar
  32. 32.
    Cincik H, Ferguson BJ. The impact of endoscopic cultures on care in rhinosinusitis. Layngoscope 2006;116:1562–1568.CrossRefGoogle Scholar
  33. 33.
    Griffith DE. Therapy of nontuberculous mycobacterial disease. Curr Opin Infect Dis 2007;20:198–203.PubMedCrossRefGoogle Scholar
  34. 34.
    Hart CA, Rao SK. Rhinoscleroma. J Med Microbiol 2000;49:395–396.PubMedGoogle Scholar
  35. 35.
    Yilmaz M, Aydil U, Vural C, et al. Simultaneous occurrence of nasal and cervical rhinoscleroma. J Otolaryngol 2006;35:206–208.PubMedGoogle Scholar
  36. 36.
    Chain JR, Kingdom TT. Non-Hodgkin’s lymphoma of the frontal sinus presenting as osteomyelitis. Am J Otolaryngol 2006;28:42–45.CrossRefGoogle Scholar
  37. 37.
    Thompson LD. Mini-symposium: head and neck pathology—sinonasal carcinomas. Curr Diagn Pathol 2006;12:40–53.CrossRefGoogle Scholar
  38. 38.
    Al-Hakeem DA, Fedele S, Carlos R, et al. Extranodal NK/T-cell lymphoma, nasal type. Oral Oncol 2007;43:4–14.PubMedCrossRefGoogle Scholar
  39. 39.
    Chen S, Wu CS, Chan K, et al. Primary sinonasal non-Hodgkin’s lymphoma masquerading as chronic rhinosinusitis: an issue of routine histopathological examination. J Laryngol Otol 2003;117:404–407.PubMedCrossRefGoogle Scholar
  40. 40.
    Sabbà C. A rare and misdiagnosed bleeding disorder: hereditary hemorrhagic telangiectasia. J Thromb Haemost 2005;3:2201–2210.PubMedCrossRefGoogle Scholar
  41. 41.
    Kühnel TS, Wagner BH, Schurr CP, et al. Clinical strategy in hereditary hemorrhagic telangiectasia. Am J Rhinol 2005;19:508–513.PubMedGoogle Scholar
  42. 42.
    Geisthoff UW, Sittel C, Plinkert PK. Contact endoscopic findings in hereditary hemorrhagic telangiectasia. Head Neck 2005;28:56–63.CrossRefGoogle Scholar
  43. 43.
    HHT Foundation International. Hereditary Hemorrhagic Telangiectasia page. Available at: Accessed July 12, 2007.
  44. 44.
    Prasad HK, Bhojwani KM, Shnoy V. HIV manifestations in otolaryngology. Am J Otolaryngol 2006;27:179–185.PubMedCrossRefGoogle Scholar
  45. 45.
    Milgrim LM, Rubin JS, Small CB. Mucociliary clearance abnormalities in the HIV-infected patient: a precursor to acute sinusitis. Larnygoscope 1995;105:1202–1208.CrossRefGoogle Scholar
  46. 46.
    Godofsky EW, Zinreich J, Armstrong M, et al. Sinusitis in HIV-infected patients: a clinical and radiographic review. Am J Med 1992;93:163–170.PubMedCrossRefGoogle Scholar
  47. 47.
    Centers for Disease Control. Revised Recommendations for HIV testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings page. Available at: mmwr/preview/mmwrhtml/rr5514a1.htm. Accessed July 12, 2007.
  48. 48.
    Yeni PG, Hammer SM, Hirsch MS, et al. Treatment for adult HIV infection: 2004 recommendations of the International AIDS Society-USA panel. JAMA 2004;292:251–265.PubMedCrossRefGoogle Scholar
  49. 49.
    Wawrose SF, Tami TA, Amoits CP. The role of guaifenesin in the treatment of sinonasal disease in patients infected with the human immunodeficiency virus. Laryngoscope 1992;102:1225–1228.PubMedCrossRefGoogle Scholar
  50. 50.
    Tomooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope 2000;110:1189–1193.PubMedCrossRefGoogle Scholar
  51. 51.
    Shafinoori S, Ginocchio CC, Greenberg AJ, et al. Impact of pneumococcal conjugate vaccine and the severity of winter influenza-like illnesses on invasive pneumococcal infections in children and adults. Pediatr Infect Dis J 2005;24:10–16.PubMedCrossRefGoogle Scholar
  52. 52.
    Talbott JF, Gorti GK, Koch RJ. Midfacial osteomyelitis in a chronic abuser: a case report. Ear Nose Throat J 2001; 80:738–743.Google Scholar
  53. 53.
    Neugebauer P, Fricke J, Neugebauer A, et al. Sinuorbital complications after intranasal cocaine abuse. Strabismus 2004;12:205–209.PubMedCrossRefGoogle Scholar
  54. 54.
    Leibovitch I, Khoramian D, Goldberg RA. Severe destructive sinusitis and orbital apex syndrome as a complication of intranasal cocaine abuse. Am J Emerg Med 2006;24:499–501.PubMedCrossRefGoogle Scholar
  55. 55.
    Gordon RJ, Lowy FD. Bacterial infection in drug users. N Engl J Med 2005;353:1945–1954.PubMedCrossRefGoogle Scholar
  56. 56.
    Klutmans J, van Belkum A, Verburgh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505–520.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Christine Reger
  • Christina F. Herrera
  • Megan Abbott
  • Alexander G. Chiu
    • 1
  1. 1.Department of OtorhinolaryngologyUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations