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2.1
Chronic Granulomatous Rhinitis
Granulomatous Rhinitis (chronic)

Presentation

Clinical description CGD can present at any age but is most commonly diagnosed before the age of 5 years. [orpha.net]

It may be present only during a specific season, or present year-round with or without periods of worsening. Mechanisms of allergic rhinitis Allergic rhinitis is defined by the presence of antibodies (IgE) which recognize certain allergens. [allerg.qc.ca]

Diseases that can present in this manner include autoimmune vasculitis, sarcoidosis, indolent infections, neoplastic processes, and various other miscellaneous conditions. [ncbi.nlm.nih.gov]

However, HP as an initial presentation of CGD is uncommon and has never been reported. [ojrd.biomedcentral.com]

Other symptoms at the time of presentation include severe nasal congestion/obstruction, sinus pain/pressure, headaches and facial numbness. [aspergillus.org.uk]

Entire Body System

  • Weight Loss

    Clinical signs related to Bartonella infection in dogs: Endocarditis Myocarditis Anaemia Hepatitis Polyarthritis Uveitis, choroiditis Weight loss Epistaxis [cvbd.org]

    It is caused by an air-borne bacteria and causes symptoms like coughing, fever, sweating, and weight loss. [militarydisabilitymadeeasy.com]

    Weight loss, fatigue, night sweats, fever, or just an overall feeling of ill health can also be clues to the disease. [medicinenet.com]

  • Congestive Heart Failure

    The ratings: If the condition causes the right ventricle in the heart to swell and fail because of high blood pressure between the heart and lungs, or if there is congestive heart failure, or if it causes lung disease that continually gets worse despite [militarydisabilitymadeeasy.com]

  • Constitutional Symptom

    symptoms and non-necrotizing granulomas in walls of alveoli and airways. [ojrd.biomedcentral.com]

Respiratoric

  • Nasal Congestion

    congestion) Mixed rhinitis Non-allergic nasal rhinitis with eosinophilia Nonallergic rhinitis Non-allergic rhinitis Nonallergic rhinitis with eosinophilia Purulent rhinitis Rhinitis Rhinitis (nasal congestion) Rhinitis (nasal congestion), chronic Rhinitis [icd9data.com]

    Clinical manifestations of rhinitis include nasal congestion, sneezing, rhinorrhea, and post-nasal drip. [amboss.com]

    Rhinitis is inflammation of the nasal mucous membrane, with resultant nasal congestion, rhinorrhea, and variable associated symptoms depending on etiology (eg, itching, sneezing, watery or purulent rhinorrhea, anosmia). [merckmanuals.com]

    Symptoms initially include some nasal congestion and thin nasal discharge, often with a scratchy or sore throat. [my.clevelandclinic.org]

Gastrointestinal

  • Diarrhea

    Crohn disease Patients may display GI bleeding, prolonged diarrhea with abdominal pain, fistulae between the GI, GU, and vaginal walls, and perianal skin tags. Nitroblue tetrazolium test/dihydrorhodamine (DHR) 123 test are normal. [online.epocrates.com]

    Up to 50% of patients present with diarrhea, abdominal pain, and failure to thrive. Pneumonia, abscesses, cellulitis, adenitis and osteomyelitis are common. [orpha.net]

    Additional GI manifestations including non-infectious colitis, enteritis, peri-anal disease, diarrhea, vomiting, aphthous ulcers and gingivitis are also common among patients with CGD [ 2 - 6 ]. [omicsonline.org]

    Gastrointestinal problems can also occur, including diarrhea, abdominal pain, and perianal abscesses. [rarediseases.org]

Face, Head & Neck

  • Epistaxis

    Clinical signs related to Bartonella infection in dogs: Endocarditis Myocarditis Anaemia Hepatitis Polyarthritis Uveitis, choroiditis Weight loss Epistaxis [cvbd.org]

    Granulomatosis with polyangiitis, known for the triad of respiratory tract granulomas, systemic vasculitis and glomerulonephritis, commonly produces nasal symptoms of crusting, epistaxis and rhinorrhea. [my.clevelandclinic.org]

    Epistaxis Diagnostics : No specific diagnostic test is indicated. Treatment : No form of treatment can completely eliminate symptoms. [amboss.com]

    • 3 main forms of WG – Type 1 • Limited form • Symptoms of URTI persisting for weeks & not responding to A/b • Pain over the dorsum of the nose • Epistaxis & variable degree of nasal obstruction • Very large crusting of the nasal cavities & nasopharynx [slideshare.net]

    Patients often endure symptoms of chronic rhinosinusitis such as sinus pain, nasal discharge, headache (Jhuo, 2011), low-grade fever and intermittent epistaxis. Invasion of the maxillary floor leads to palatal erosions. [aspergillus.org.uk]

Neurologic

  • Stroke

    Occasionally, invasion of adjacent structures such as the orbit, cavernous sinus, and anterior cranial fossa may lead to epidural abscess, parenchymal cerebritis or abscess, meningitis, cavernous sinus thrombosis, osteomyelitis, mycotic aneurism, stroke [aspergillus.org.uk]

    JAN-FEB 2002; 20 (1) : 19-26 Sivakumar-MR; Chandrakantan-A A rare case of stroke in Wegener's granulomatosis CEREBROVASCULAR-DISEASES. 2002; 13 (2) : 143-144 Aasarod-K; Iversen-BM; Hammerstrom-J; Bostad-L; Jorstad-S Clinical outcome of patients with Wegener's [malattierare.regione.veneto.it]

  • Neurologic Manifestation

    Griscelli syndrome type 3, characterized by hypomelanosis with no immunologic or neurologic manifestations, is caused by mutation in the melanophilin (MLPH gene). [primaryimmune.org]

    FEB 14 2002; 346 (7) : 513-520 Nadeau-SE Neurologic manifestations of systemic vasculitis NEUROLOGIC-CLINICS. [malattierare.regione.veneto.it]

Urogenital

  • Renal Insufficiency

    Pharmacokinetics of cetirizine in the elderly and patients with renal insufficiency. Ann Allergy 1987; 59 (Pt 2): 25–30 PubMed Google Scholar 15. Lake CR, Gallant S, Masson E, et al. [link.springer.com]

    Case Presentation A 77-year-old male with multiple medical problems including hypertension, hyperlipidemia, chronic renal insufficiency and obesity, who has been followed in the Michael E. [bcm.edu]

  • Hematuria

    • 3 main forms of WG – Type 3 • Widely disseminated with involvement of multiple organs – Airway » Short segment of subglottic/upper tracheal stenosis – Pulmonary – Renal » Hematuria & abn urinary sediment & segmental/diffuse glomerulonephritis – Cutaneous [slideshare.net]

Workup

A screening immunodeficiency workup is listed in Table 4. I maging The most useful test for imaging the paranasal sinuses is a coronal sinus CT scan. [antimicrobe.org]

Treatment

Patients may also benefit from treatment of allergy with immunotherapy (allergy shots or drops) and antihistamines. Anti-fungal treatment is usually not required, as it is the reaction to the fungus that needs to be modulated. [care.american-rhinologic.org]

[…] and after treatment. [clinicaltrials.gov]

Videos: Choosing Wisely » CGD Treatment & Management The best treatment plan for CGD is to prevent infections from occurring. Special preventative antibiotics are a mainstay of treatment for CGD. These greatly reduce the chances of infection. [aaaai.org]

Medical Treatment In order to understand treatment, it is helpful to revisit the poison ivy analogy... [fauquierent.net]

Given the great amount of fungi exposures you have, remarkably few fungal infections require medical treatment. However fungal sinus disease does require medications and treatment and increasingly is recognized as a source of chronic sinusitis. [theasthmacenter.org]

Prognosis

Prognosis The prognosis has greatly improved with the use of antibacterial and antifungal prophylaxis therapy, with most patients living well into adulthood. The documents contained in this web site are presented for information purposes only. [orpha.net]

Treatment and prognosis There is scarce evidence regarding optimal management and follow up in the literature. [radiopaedia.org]

Outlook and prognosis Nearly all patients survive with radical resection surgery and antifungal therapy, if the diagnosis is not made too late. [life-worldwide.org]

Some authors suggested that angioinvasion might be an independent variable that predicts a worse prognosis in chronic invasive fungal rhinosinusitis. [aspergillus.org.uk]

What is the prognosis of sarcoidosis? The prognosis of sarcoidosis is generally very good. The prognosis ultimately depends on the location and severity of involvement with the sarcoid inflammation. [medicinenet.com]

Etiology

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Rhinitis is inflammation of the nasal mucous membrane, with resultant nasal congestion, rhinorrhea, and variable associated symptoms depending on etiology (eg, itching, sneezing, watery or purulent rhinorrhea, anosmia). [merckmanuals.com]

The etiology is an allergic reaction to pollen or fungal spores. Signs are seasonal and occur under warm, moist conditions; they include rhinorrhea, sneezing, and a sudden onset of dyspnea. [msdvetmanual.com]

Manifestation code identifies conditions for which it is important to record both the etiology and the symptom of the disease. [books.google.de]

Classification Allergic rhinitis Definition : acute or chronic rhinitis caused by exposure to an inhaled allergen Etiology Type I hypersensitivity reaction Genetic predisposition to atopy Clinical features Recurrent episodes of sneezing, nasal congestion [amboss.com]

Epidemiology

Summary Epidemiology The average worldwide birth prevalence is estimated at 1/ 217,000. Clinical description CGD can present at any age but is most commonly diagnosed before the age of 5 years. [orpha.net]

Epidemiology of asthma and allergic rhinitis in a total community, Tecumseh, Michigan. J Allergy Clin Immunol 1974; 53: 127–38 PubMed CrossRef Google Scholar 5. Drake-Lee AB, Lowe D, Swanston DL, et al. [link.springer.com]

Epidemiology and outcome of invasive fungal diseases in patients with chronic granulomatous disease: a multicenter study in France. Pediatr Infect Dis J. 2011;30(1):57-62. [revistaalergia.mx]

Classification and epidemiology The most recent and widely classification categorized rhinosinusitis as invasive and non-invasive is based on the histopathological findings of the invaded tissue (Deshazo, 1997; Das, 2009). [aspergillus.org.uk]

The epidemiology of chronic rhinosinusitis in Canadians. Laryngoscope. 2003;113(7):1199–205. [PubMed] [Google Scholar] 2. Joe SA, Thambi R, Huang J. A systematic review of the use of intranasal steroids in the treatment of chronic rhinosinusitis. [ncbi.nlm.nih.gov]

Pathophysiology

Our understanding of pathophysiology certainly leaves a lot of room for improvement. [bcm.edu]

Chronic granulomatous disease: epidemiology, pathophysiology, and genetic basis of disease. J Pediatric Infect Dis Soc. 2018;7(Suppl 1):S2-S5. DOI: 10.1093/jpids/piy008 Rawat A, Bhattad S, Singh S. Chronic granulomatous disease. [revistaalergia.mx]

Seger RA (2010) Chronic granulomatous disease: recent advances in pathophysiology and treatment. Neth J Med 68: 334-340. [omicsonline.org]

[PubMed] Tables T able 1: Some Pathophysiologic Factors Associated With CRS Host Environmental Autoimmune disease Allergens Ciliary Dysfunction Bacteria Cystic Fibrosis Fungi Granulomatous Disorders Irritants/Pollutants Immunodeficiency Smoking Prior [antimicrobe.org]

Prevention

Videos: Choosing Wisely » CGD Treatment & Management The best treatment plan for CGD is to prevent infections from occurring. Special preventative antibiotics are a mainstay of treatment for CGD. These greatly reduce the chances of infection. [aaaai.org]

Treatment involves prophylactic antibiotics to prevent staphylococcal and fungal infections, and prompt prescription of antibiotics to treat infections. Administration of interferon gamma and bone marrow transplantation may be needed in severe cases. [columbiadoctors.org]

Prevention and treatment It is important to enact environmental control measures to avoid the allergens that are causing the problem (see the section on Respiratory allergens ). [allerg.qc.ca]

Is it possible to prevent sarcoidosis? The cause of sarcoidosis still remains unknown, so there is at present no known way to prevent or cure this disease. However, doctors have had a great deal of experience in management of the illness. [medicinenet.com]

Management and treatment Antibacterial and antifungal prophylaxis is essential in preventing the infections seen in CGD. Lifelong daily doses of trimethoprim-sulfamethoxazole (antibacterial) and itraconazole (anti-fungal) are recommended. [orpha.net]

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