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Clinical Challenge
March 2018

Nasopharyngeal Swelling in a Patient With Cystic Fibrosis Following Endoscopic Sinus Surgery

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
  • 2New York–Presbyterian Hospital–Columbia University Irving Medical Center, New York, New York
JAMA Otolaryngol Head Neck Surg. 2018;144(3):268-269. doi:10.1001/jamaoto.2017.2764

A woman in her 20s with a history of cystic fibrosis underwent bilateral endoscopic sinus surgery and medial maxillectomy 4 months after bilateral lung transplantation. She presented to her rhinologist for follow-up 6 weeks after surgery reporting improved nasal obstruction and olfaction, but complained of 2 weeks of throat pain and swelling. Physical examination revealed bilateral tonsillar erythema, exudate, tenderness, and peritonsillar edema. She was prescribed amoxicillin–clavulanic acid for presumed tonsillitis and began to improve. Two weeks later her symptoms returned, now accompanied by new-onset snoring and nasal obstruction. Nasal endoscopy revealed nasopharyngeal soft-tissue swelling with mucopurulent secretions on the left side. She was referred for a computed tomographic scan with contrast, which showed a rim-enhancing, multilocular hypodense collection extending from the left nasopharynx inferiorly to the level of the right palatine tonsil (Figure 1). On the basis of the radiographic findings, she was taken to the operating room urgently. Intraoperative endoscopy revealed ulceration and necrotic debris in the nasopharynx and oropharynx. Culture and biopsy specimens were obtained.

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