Clinical and epidemiological profile of patients with nasal manifestations of granulomatous disorders in a rural tertiary care centre
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20173150Keywords:
Leishmaniasis, Cutaneous, Granulomatosis with Polyangiitis, Granulomatosis, Orofacial, TuberculosisAbstract
Background: Most of the times granulomatous disorders have obvious manifestations; however, sometimes they are difficult to diagnose. A literature review reveals that patients with granulomatous diseases may be frequently incorrectly diagnosed and treated.At present limited data is available on the clinical and epidemiological profile of such patients in rural India. As such rural setup lacks the expert services of rheumatologist and the patients are frequently inconsistent with diagnostic protocols despite best efforts of the clinicians.
Methods: This is a prospective study conducted in a tertiary care centre at Bhuj, Gujarat, India between January 2016 and May 2017. Patients included in the study had multi systemic complaints along with nasal manifestations such as recurrent epistaxis, saddling, synechia or swelling over nose. These patients were subjected to detailed history taking including demographic profile. They underwent detailed ENT examination, biopsies, radiological and serological tests and were discussed at multidisciplinary review meetings which involved physicians, otorhinolaryngologists, dermatologist, ophthalmologist, pathologist and radiologist.
Results: Of the 19 patients included in this study, 53% patients were females. 84% (16 patients) belonged to rural household and 68% (13 patients) belonged to lower socioeconomic status. 9 patients (47%) were diagnosed with tuberculosis while Wegener’s granulomatosis and leprosy accounted for 3 cases (16%) each. 2 patients each were diagnosed with Cutaneous Leishmaniasis and fungal granulomas respectively. The average period between onset of symptoms and final diagnosis was 8 months. However, it took an average of 4.75 days after patient arrived at our centre to reach a final diagnosis.
Conclusions:Early diagnosis of granulomatous disorders requires a multidisciplinary approach. The role of ENT surgeons is obvious as many granulomatous disorders have nasal manifestations. A multidisciplinary approach helps cut short the time between onset of disease and diagnosis, thus benefitting the patients by reducing the hospital stay and visits as most of these illnesses require outpatient treatment.
Background: Most of the times granulomatous disorders have obvious manifestations; however, sometimes they are difficult to diagnose. A literature review reveals that patients with granulomatous diseases may be frequently incorrectly diagnosed and treated.At present limited data is available on the clinical and epidemiological profile of such patients in rural India. As such rural setup lacks the expert services of rheumatologist and the patients are frequently inconsistent with diagnostic protocols despite best efforts of the clinicians.
Methods: This is a prospective study conducted in a tertiary care centre at Bhuj, Gujarat, India between January 2016 and May 2017. Patients included in the study had multi systemic complaints along with nasal manifestations such as recurrent epistaxis, saddling, synechia or swelling over nose. These patients were subjected to detailed history taking including demographic profile. They underwent detailed ENT examination, biopsies, radiological and serological tests and were discussed at multidisciplinary review meetings which involved physicians, otorhinolaryngologists, dermatologist, ophthalmologist, pathologist and radiologist.
Results: Of the 19 patients included in this study, 53% patients were females. 84% (16 patients) belonged to rural household and 68% (13 patients) belonged to lower socioeconomic status. 9 patients (47%) were diagnosed with tuberculosis while Wegener’s granulomatosis and leprosy accounted for 3 cases (16%) each. 2 patients each were diagnosed with Cutaneous Leishmaniasis and fungal granulomas respectively. The average period between onset of symptoms and final diagnosis was 8 months. However, it took an average of 4.75 days after patient arrived at our centre to reach a final diagnosis.
Conclusions: Early diagnosis of granulomatous disorders requires a multidisciplinary approach. The role of ENT surgeons is obvious as many granulomatous disorders have nasal manifestations. A multidisciplinary approach helps cut short the time between onset of disease and diagnosis, thus benefitting the patients by reducing the hospital stay and visits as most of these illnesses require outpatient treatment.
Metrics
References
Heyworth P, Cross A, Curnutte J. Chronic granulomatous disease. Curr Opin Immunol. 2003;15(5):578–84.
Zafar U, Khan N, Afroz N, Hasan S. A Clinicopathological study of non-neoplastic lesions of nasal cavity and paranasal sinuses. Indian J Pathol Microbiol. 2008;51:26-9.
Tondon PL, Gulati J, Mehta N. Histological study of polypoidal lesions in the nasal cavity. Indian J Otolaryngol. 1971;23:3-10.
Weir MR, Thornton GF. Extrapulmonary tuberculosis. Experience of a community hospital and review of the literature. Am J Med. 1985;79:467–78.
Kumar B, Kaur S. Pattern of cutaneous tuberculosis in North India. Indian J Dermatol Venereol Leprol. 1986;52(4):203-7.
Sehgal VN, Srivastava G, Khurana VK, Sharma VK, Bhalla P, Beohar PC. An appraisal of epidemiologic, clinical, bacteriologic, histopathologic, and immunologic parameters in cutaneous tuberculosis. Int J Dermatol. 1987;26(8):521-6.
Tigoulet F, Fournier V, Caumes E. Clinical forms of the cutaneous tuberculosis. Bull Soc Pathol Exot. 2003;96(5):362-7.
Kumar B, Muralidhar S. Cutaneous tuberculosis: a twenty-year prospective study. Int J Tuberc Lung Dis. 1999;3(6):494-500.
Morales-Angulo C, García-Zornoza R, Obeso-Agüera S, Calvo-Alén J, González-Gay MA. Ear, Nose and Throat Manifestations of Wegener's Granulomatosis (Granulomatosis With Polyangiitis). Acta Otorrinolaringol Esp. 2012;63(3):206-11.
Duggal L, Jain N. Limited Wegener’s Granulomatosis. JIACM. 2004;5(2):186-7.
Sharma A, Gopalakrishan D, Nada R, Kumar S, Dogra S, Aggarwal M, et al. Uncommon presentations of primary systemic necrotizing vasculitides: the Great Masquerades. Int J Rheum Dis. 2014;17:562–72.
Wani GM, Ahmad SM, Khursheed B. Clinical study of cutaneous leishmaniasis in the Kashmir Valley. Indian Dermatol Online J. 2015;6:387-92.
Bhargava EK, Rana K. Cutaneous Leishmaniasis: The Grand Masquerade. Otolaryngol Head Neck Surg. 2015;153(4):681-2.
Kocarslan S, Turan E, Ekinci T, Yesilova Y, Apari R. Clinical and histopathological characteristics of cutaneous leishmaniasis in Sanliurfa City of Turkey including Syrian refugees. Indian J Pathol Microbiol. 2013;56:211–5.
Saab J, Fedda F, Khattab R, Yahya L, Loya A, Satti M, et al. Cutaneous leishmaniasis mimicking inflammatory and neoplastic processes: a clinical, histopathological and molecular study of 57 cases. J Cutan Pathol. 2012;39(2):251-62.
Downloads
Published
How to Cite
Issue
Section
