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Clinical Challenge
August 2016

Rhinosinusitis and Parotid Enlargement in a Young African American Man

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
  • 2Department of Otolaryngology–Head and Neck Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
JAMA Otolaryngol Head Neck Surg. 2016;142(8):795-796. doi:10.1001/jamaoto.2015.3971

A young African American man presented with a 6-month history of nasal congestion, facial pressure, purulent rhinorrhea, and hypo-osmia that had not improved despite multiple courses of antibiotics and steroids. His medical history was significant for chronic rhinosinusitis, allergic rhinitis, and asthma, for which he took fluticasone propionate and salmeterol (Advair) and albuterol. A review of systems revealed epiphora and ocular crusting for 4 months. Findings on nasal endoscopy included bilateral turbinate hypertrophy and significant nasal crusting. A computed tomographic (CT) scan of the sinuses revealed diffuse mucosal thickening consistent with pansinusitis (Figure, A). All laboratory results from an autoimmune workup were normal for angiotensin-converting enzyme (ACE) level, antineutrophil cytoplasmic antibodies, antinuclear antibody, and immunoglobulin levels. He had a normal chest radiograph. The patient was lost to follow-up but returned several months later with 6 weeks of progressive bilateral parotid swelling (Figure, B). His parotid glands were diffusely enlarged and tender, and his facial function was normal. Radiologically, no masses or sialoliths were seen (Figure, C). His only associated symptoms were fevers and fatigue. A history of recent tuberculosis exposure was obtained. Test results for SSa/SSb levels, human immunodeficiency virus (HIV), polymerase chain reaction (PCR), mumps titers, rapid plasma reagin, amylase, cytomegalovirus PCR, and quantiferon testing were negative. A superficial parotid biopsy revealed noncaseating granulomatous inflammation (Figure, D).

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