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- Elizabeth Ninan, MD*
- Stefan Hagmann, MD, MSc*
- *Albert Einstein College of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY.
AUTHOR DISCLOSURE
Drs Ninan and Hagmann have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Presentation
A 17-year-old girl who has a history of asthma and chronic allergic rhinitis presents with a 12-month history of persistent nasal congestion, rhinorrhea, facial pain, and headache. The diagnosis of asthma had been established at age 8 years and chronic allergic rhinitis at age 12 years. Her routine home medications include albuterol, nasal corticosteroids, antihistamines, and topical nasal decongestants. Her symptoms worsened over the last several months, and an 8-week course of oral antibiotics followed by oral corticosteroids for 2 weeks did not lead to notable symptomatic relief.
At initial presentation, she is afebrile (36.9°C [98.5°F]), with a heart rate of 96 beats per minute, respiratory rate of 18 breaths per minute, blood pressure of 96/62 mm Hg, and oxygen saturations of 99% in room air. On physical examination she is a BMI of 24.5 and appears uncomfortable. Head and neck examination reveals a nasal crease, allergic “shiners,” bilateral nasal polyps, and frontal and maxillary sinus tenderness. On auscultation, clear breath sounds without any added sounds are audible over both lungs. Findings of the remainder of the physical examination are unremarkable.
Laboratory studies reveal a white blood cell count of 6,200/μL (6.2 × 109/L), with 8.4% eosinophils on the differential cell count. Computed tomography (CT) scan of …
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