Case presentation of a patient with severe nasal polyposis: Use of primary biologic therapy without prior nasal sinus surgery

Introduction Biologic therapies represent new, highly effective treatment options for severe uncontrolled chronic rhinosinusitis with nasal polyposis (CRSwNP). In accordance with international and national recommendations and the eligibility criteria of biologics in the indication CRSwNP, biologic therapies are typically performed in patients who have previously undergone nasal sinus surgery and still have no control of the disease. In the case presentation, a patient with severe nasal polyposis will be presented with a primary biologic therapy.

Method Case presentation.

Results Presentation of a 37-year-old male patient with CRSwNP, asthma and NSAID-exacerbated respiratory disease (N-ERD). Prior treatment with topical or oral corticosteroids had not shown sufficient effect. Initial findings: nasal polyposis (NP)-score of 8, total IgE 295 kU/l, eosinophils 2.2%. Due to severe anaphylaxis to atracurium, a non-depolarizing muscle relaxant, a nasal sinus surgery was not performed. After allergological diagnostics, anesthesiological consultation and at the patient's request, the patient was primarily adjusted to dupilumab (anti-IL-4Ra antibody). In the follow-up, a polyposis score of 1 was examined. A demonstration of the clinical findings will be given.

Conclusion The present case illustrates that in patients with severe nasal polyposis, primary biologic therapy without prior nasal sinus surgery is indicated in individual cases, as in the present case after severe anaphylactic reaction to muscle relaxants.

Publication History

Article published online:
19 April 2024