Chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis: clinical presentation and antineutrophil cytoplasmic antibodies

Christopher M. Low, Karina A. Keogh, Elias S. Saba, Nelson R. Gruszczynski, Alvise Berti, Ulrich Specks, Misbah Baqir, Byron M. Smith, Garret Choby, Janalee K. Stokken, Erin K. O'Brien

Research output: Contribution to journalArticle

Abstract

Background: In this study we aim to describe presenting characteristics and identify prognostic factors for disease resolution in patients with chronic rhinosinusitis (CRS) in the setting of eosinophilic granulomatosis with polyangiitis (EGPA). Methods: Patients evaluated at a tertiary care center with diagnoses of EGPA and CRS were identified. Descriptive statistics were obtained. Univariate analysis was used to search for prognostic factors associated with higher Lund-Mackay score at presentation and disease resolution. Results: Forty-four patients were included with a mean age of 52.7 (standard deviation, 14) years. Twenty-one patients (47.7%) were female, all had a diagnosis of asthma, and 36 (83.7%) had eosinophils >10%. Common presenting symptoms for CRS included nasal discharge (87.9%) followed by nasal congestion (83.9%) and facial pain and pressure (83.8%). Medical management of CRS included systemic corticosteroids (93.2%) and systemic antibiotics (75%). Surgical intervention occurred in 29 patients (67%). Nine patients (20.5%) had resolution of sinus symptoms, including 4 with imaging confirmation. Fourteen patients (31.8%) had continued CRS, but with improved symptoms, whereas 9 patients (20.5%) had continued CRS with no improvement in symptoms. Eleven patients (25%) were lost to follow-up and 4 (9.1%) died. Univariate analysis did not show antineutrophil cytoplasmic antibody positivity, presence of peripheral eosinophilia, gender, age, or absence of systemic therapy to be predictive of higher Lund-Mackay score at presentation or predictive of disease resolution. Conclusion: CRS in patients with EGPA is often refractory to medical and surgical management. Treatment of these patients should occur in a multidisciplinary setting.

Original languageEnglish (US)
JournalInternational Forum of Allergy and Rhinology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Antineutrophil Cytoplasmic Antibodies
Granulomatosis with Polyangiitis
Nose
Facial Pain
Lost to Follow-Up
Eosinophilia
Eosinophils
Tertiary Care Centers
Adrenal Cortex Hormones
Asthma

Keywords

  • chronic rhinosinusitis
  • Churg-Strauss syndrome
  • CRS
  • CSS
  • EGPA
  • eosinophilic granulomatosis with polyangiitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis : clinical presentation and antineutrophil cytoplasmic antibodies. / Low, Christopher M.; Keogh, Karina A.; Saba, Elias S.; Gruszczynski, Nelson R.; Berti, Alvise; Specks, Ulrich; Baqir, Misbah; Smith, Byron M.; Choby, Garret; Stokken, Janalee K.; O'Brien, Erin K.

In: International Forum of Allergy and Rhinology, 01.01.2019.

Research output: Contribution to journalArticle

Low, Christopher M. ; Keogh, Karina A. ; Saba, Elias S. ; Gruszczynski, Nelson R. ; Berti, Alvise ; Specks, Ulrich ; Baqir, Misbah ; Smith, Byron M. ; Choby, Garret ; Stokken, Janalee K. ; O'Brien, Erin K. / Chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis : clinical presentation and antineutrophil cytoplasmic antibodies. In: International Forum of Allergy and Rhinology. 2019.
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title = "Chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis: clinical presentation and antineutrophil cytoplasmic antibodies",
abstract = "Background: In this study we aim to describe presenting characteristics and identify prognostic factors for disease resolution in patients with chronic rhinosinusitis (CRS) in the setting of eosinophilic granulomatosis with polyangiitis (EGPA). Methods: Patients evaluated at a tertiary care center with diagnoses of EGPA and CRS were identified. Descriptive statistics were obtained. Univariate analysis was used to search for prognostic factors associated with higher Lund-Mackay score at presentation and disease resolution. Results: Forty-four patients were included with a mean age of 52.7 (standard deviation, 14) years. Twenty-one patients (47.7{\%}) were female, all had a diagnosis of asthma, and 36 (83.7{\%}) had eosinophils >10{\%}. Common presenting symptoms for CRS included nasal discharge (87.9{\%}) followed by nasal congestion (83.9{\%}) and facial pain and pressure (83.8{\%}). Medical management of CRS included systemic corticosteroids (93.2{\%}) and systemic antibiotics (75{\%}). Surgical intervention occurred in 29 patients (67{\%}). Nine patients (20.5{\%}) had resolution of sinus symptoms, including 4 with imaging confirmation. Fourteen patients (31.8{\%}) had continued CRS, but with improved symptoms, whereas 9 patients (20.5{\%}) had continued CRS with no improvement in symptoms. Eleven patients (25{\%}) were lost to follow-up and 4 (9.1{\%}) died. Univariate analysis did not show antineutrophil cytoplasmic antibody positivity, presence of peripheral eosinophilia, gender, age, or absence of systemic therapy to be predictive of higher Lund-Mackay score at presentation or predictive of disease resolution. Conclusion: CRS in patients with EGPA is often refractory to medical and surgical management. Treatment of these patients should occur in a multidisciplinary setting.",
keywords = "chronic rhinosinusitis, Churg-Strauss syndrome, CRS, CSS, EGPA, eosinophilic granulomatosis with polyangiitis",
author = "Low, {Christopher M.} and Keogh, {Karina A.} and Saba, {Elias S.} and Gruszczynski, {Nelson R.} and Alvise Berti and Ulrich Specks and Misbah Baqir and Smith, {Byron M.} and Garret Choby and Stokken, {Janalee K.} and O'Brien, {Erin K.}",
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T1 - Chronic rhinosinusitis in eosinophilic granulomatosis with polyangiitis

T2 - clinical presentation and antineutrophil cytoplasmic antibodies

AU - Low, Christopher M.

AU - Keogh, Karina A.

AU - Saba, Elias S.

AU - Gruszczynski, Nelson R.

AU - Berti, Alvise

AU - Specks, Ulrich

AU - Baqir, Misbah

AU - Smith, Byron M.

AU - Choby, Garret

AU - Stokken, Janalee K.

AU - O'Brien, Erin K.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: In this study we aim to describe presenting characteristics and identify prognostic factors for disease resolution in patients with chronic rhinosinusitis (CRS) in the setting of eosinophilic granulomatosis with polyangiitis (EGPA). Methods: Patients evaluated at a tertiary care center with diagnoses of EGPA and CRS were identified. Descriptive statistics were obtained. Univariate analysis was used to search for prognostic factors associated with higher Lund-Mackay score at presentation and disease resolution. Results: Forty-four patients were included with a mean age of 52.7 (standard deviation, 14) years. Twenty-one patients (47.7%) were female, all had a diagnosis of asthma, and 36 (83.7%) had eosinophils >10%. Common presenting symptoms for CRS included nasal discharge (87.9%) followed by nasal congestion (83.9%) and facial pain and pressure (83.8%). Medical management of CRS included systemic corticosteroids (93.2%) and systemic antibiotics (75%). Surgical intervention occurred in 29 patients (67%). Nine patients (20.5%) had resolution of sinus symptoms, including 4 with imaging confirmation. Fourteen patients (31.8%) had continued CRS, but with improved symptoms, whereas 9 patients (20.5%) had continued CRS with no improvement in symptoms. Eleven patients (25%) were lost to follow-up and 4 (9.1%) died. Univariate analysis did not show antineutrophil cytoplasmic antibody positivity, presence of peripheral eosinophilia, gender, age, or absence of systemic therapy to be predictive of higher Lund-Mackay score at presentation or predictive of disease resolution. Conclusion: CRS in patients with EGPA is often refractory to medical and surgical management. Treatment of these patients should occur in a multidisciplinary setting.

AB - Background: In this study we aim to describe presenting characteristics and identify prognostic factors for disease resolution in patients with chronic rhinosinusitis (CRS) in the setting of eosinophilic granulomatosis with polyangiitis (EGPA). Methods: Patients evaluated at a tertiary care center with diagnoses of EGPA and CRS were identified. Descriptive statistics were obtained. Univariate analysis was used to search for prognostic factors associated with higher Lund-Mackay score at presentation and disease resolution. Results: Forty-four patients were included with a mean age of 52.7 (standard deviation, 14) years. Twenty-one patients (47.7%) were female, all had a diagnosis of asthma, and 36 (83.7%) had eosinophils >10%. Common presenting symptoms for CRS included nasal discharge (87.9%) followed by nasal congestion (83.9%) and facial pain and pressure (83.8%). Medical management of CRS included systemic corticosteroids (93.2%) and systemic antibiotics (75%). Surgical intervention occurred in 29 patients (67%). Nine patients (20.5%) had resolution of sinus symptoms, including 4 with imaging confirmation. Fourteen patients (31.8%) had continued CRS, but with improved symptoms, whereas 9 patients (20.5%) had continued CRS with no improvement in symptoms. Eleven patients (25%) were lost to follow-up and 4 (9.1%) died. Univariate analysis did not show antineutrophil cytoplasmic antibody positivity, presence of peripheral eosinophilia, gender, age, or absence of systemic therapy to be predictive of higher Lund-Mackay score at presentation or predictive of disease resolution. Conclusion: CRS in patients with EGPA is often refractory to medical and surgical management. Treatment of these patients should occur in a multidisciplinary setting.

KW - chronic rhinosinusitis

KW - Churg-Strauss syndrome

KW - CRS

KW - CSS

KW - EGPA

KW - eosinophilic granulomatosis with polyangiitis

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