Systemic diseases and chronic rhinosinusitis

Many systemic diseases can cause nasal symptoms, either as an initial presentation or a manifestation later in the disease process. When patients present with nasal symptoms resembling infection-such as purulent nasal discharge, crusting, and congestion-acute rhinosinusitis is likely to be diagnosed. However, when these symptoms persist despite appropriate medical therapy, other etiologies should be considered. In some cases, underlying inflammation of the nasal mucosa causes recurrent or chronic sinusitis, as in nasal polyposis or allergic rhinitis. Less frequently, systemic rather than local conditions are the cause, requiring a more detailed evaluation, comprehensive systemic management, and long-term follow-up [1]. The number of systemic illnesses that can cause nasal symptoms is substantial; only those most commonly affecting the nose and sinuses are discussed here. For purposes of discussion, the diseases have been categorized as follows: autoimmune disorders, infectious processes, and hematologic-oncologic diseases. The discussion of these processes includes common presenting nasal symptoms, physical examination findings, recommended radiographic and serologic testing, and treatment options.