Follow-up of an omalizumab therapy of a patient with ASA intolerance syndrome to control nasal polyposis and following acute therapy of a sinus cavernosus syndrome

Introduction:

Chronic rhinosinusitis (CRS) can be associated with severe orbital or endocranial complications. In the case of severe CRS with a nasal polyposis (CRSwNP), therapy methods with the anti-IgE antibody omalizumab were described. The aim of the case report is to report of a patient with a CRSwNP, in which, after acute therapy of a sinus cavernosus syndrome, an omalizumab therapy was started after an interval of 8 months and was clinically observed for a follow-up of 3 years.

Methods:

We report on a 48-year-old female patient with a CRSwNP, asthma, chronic urticaria and ASA intolerance who had received 2 nasal surgeries within 18 months and was introduced with cephalgia and diplopia in our clinic. Nasal endoscopy showed a medium-grade endonasal polyposis on both sides, CT imaging revealed a defect of the posterior wall of the sinus sphenoidalis on the left side. After appropriate surgical and antibiotic acute therapy, rhinological/allergological diagnostics were performed following an interval.

Results:

In the provocation, the ASA intolerance was confirmed, the CAP test showed a total IgE of 150 kU/l (+) with no specific allergens. The FEV1 in spirometry was 81%. Due to the endocranial complication, meningo-and pneumococcal vaccinations were performed. The patient was adjusted to omalizumab every 4 weeks. Over the course of 3 years, no endoscopic nasal polyposis were observed. Urticaria was completely declined. Asthma medicationn could be reduced.

Conclusions:

Omalizumab is an effective treatment option in a CRSwNP patient after a severe clinical course with endocranial complication.

Publication History

Publication Date:
23 April 2019 (online)