Rhinosinusitis and Parotid Enlargement in a Young African American Man

Abstract

AyoungAfricanAmericanmanpresentedwith a6-monthhistoryof nasal congestion, facial pressure, purulent rhinorrhea, and hypo-osmia that had not improved despite multiple coursesofantibiotics andsteroids.Hismedical historywassignificant for chronic rhinosinusitis, allergic rhinitis, andasthma, forwhichhetookfluticasonepropionateandsalmeterol (Advair) and albuterol. A review of systems revealed epiphora and ocular crusting for 4 months. Findings on nasal endoscopy includedbilateral turbinate hypertrophy and significant nasal crusting.A computed tomographic (CT) scanof the sinuses revealeddiffusemucosal 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 6weeks of progressive bilateral parotid swelling (Figure, B). His parotid glands were diffusely enlarged and tender, and his facial function was normal. Radiologically, nomasses or sialoliths were seen (Figure, C). His only associated symptomswere 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). Parotid biopsy specimen D Axial postcontrast CT of neck C Preoperative photograph B Coronal noncontrast CT image A