SAMTER'S TRIAD IN A 9 YEARS-OLD PATIENT: A CASE REPORT

Abstract

<h3>Introduction</h3> Samter's triad, associating asthma, nasal polyposis, and NSAIDs hypersensitivity, is rarely documented in children. The pathophysiology of such condition is probably related to a dysregulation of arachidonic acid metabolism, with a consequent imbalance between pro-inflammatory and anti-inflammatory mediators. <h3>Case Description</h3> A 9 years-old boy came to our clinic with partially controlled non atopic asthma. Suffering from a concomitant chronic rhinosinusitis, a sinus CT scan was performed, revealing the presence of nasal polyposis. Genetic disorders, and other different etiologies were excluded. Polyp surgery allowed the disappearance of local symptoms and the control of asthma symptoms. The same patient also presented an anaphylactic reaction (hypotonia, vomiting, urticaria and asthma) immediately after taking 400 mg of Ibuprofen. Oral challenges were positive for ibuprofen and diclofenac, and he was diagnosed as suffering from NSAID-exacerbated respiratory disease (NERD), and, consequently, from Samter's triad. <h3>Discussion</h3> Such condition is extremely rare in pediatrics. In fact, nasal polyposis is rarely described in the pediatric population, in children non-suffering from other underlying systemic diseases, mainly cystic fibrosis. Also, the most common form of NSAIDs hypersensitivity in children is the one associated with induced urticaria/oedema, while NERD remains less common. For these reasons, the clinical report we presented needs to be considered as a rare presentation of Samter's triad in a young, non-adolescent child and make us underline that, pediatricians, should look for such diagnosis even in younger patients.