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RHINOSINUSITIS IN POST-RENAL TRANSPLANT PATIENTS- a Diagnostic Conundrum and Treatment Dilemma
  • Shruti Baruah,
  • Tarun Ojha
Shruti Baruah
Mahatma Gandhi Medical College and Hospital

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Tarun Ojha
Mahatma Gandhi Medical College and Hospital
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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.