RHINOSINUSITIS IN POST-RENAL TRANSPLANT PATIENTS- a Diagnostic Conundrum
and Treatment Dilemma
Abstract
INTRODUCTION: Immunosuppressed Renal transplant patients are often
susceptible to upper airway infections, especially those of the
paranasal sinuses. The increasing number of cases of rhinosinusitis by
opportunistic organisms in post-renal transplant (PRT) patients has
spawned our interest to analyze this subset of patients. MATERIAL &
METHOD: A Retrospective observational Study was done on all PRT patients
who presented to the Dept. of Otorhinolaryngology, MGH, Jaipur, with
symptoms of rhinosinusitis and required hospitalization. The following
variables were studied: age at time of transplantation, gender, cause of
CRF, Pre-transplant co-morbidities, Post-transplant immunosuppressant
medications, time-interval between transplant and development of
symptoms of rhinosinusitis, presenting complaints, radiological
presentation, treatment approaches and surgical challenges experienced.
RESULT: Out of 11 patients, 8 were males (72.7%) and 3 females
(27.3%). All the patients (100%) of the study group presented with
unilateral facial pain and/or headache in about 6-12 months post-renal
transplant. The most consistent CT finding was involvement of the
Maxillary sinuses. All the cases worsened rapidly and required immediate
treatment and 9(81.8%) of these patients required Endoscopic surgical
debridement, of which 3 (27%) cases required revision surgery within 2
weeks. CONCLUSION: In the immunocompromised host, the initial
presentation of rhinosinusitis may be subtle, but the subsequent
clinical course is usually fulminant or even fatal. Therefore, their
pre-transplant ENT evaluation, a high index of suspicion in the
post-transplant period and timely management is vital to avoiding fatal
outcomes in these patients. Keywords: Rhinosinusitis, Fungal infections,
Invasive Fungal Sinusitis, Immunocompromised states, Post-renal
transplant infections. Succinct Keywords: Fungal Rhinosinusitis,
Opportunistic infections, Post-transplant Sinusitis, Chronic
Rhinosinusitis, Mucormycosis.