Case report
A 56-year-old lady, known to have diabetic mellitus, hypertension, dyslipidemia, hypothyroidism, and sinusitis. She presented to the outpatient department of ear nose and throat (ENT) six months prior to admission complaining of bilateral nasal obstruction on and off for five months associated with nasal discharge, facial rash, and erythema around nasal bridge started four months ago. She had no post-nasal drip, no change of smell, no facial pain, no ear symptoms, no throat symptoms, no hair loss nor photosensitivity. She had a history of on and off joint pain. Her social history is remarkable as she was born in Al-Khurma and lived there for fifteen years. Family history remarkable for rheumatoid arthritis in both her brother and son. On examination, she was vitally stable, afebrile. Nasal examination showed deviated nasal septum with thick nasal discharge, hypertrophied inferior turbinate, the middle meatus and nasopharynx were clear, no septal perforation. Ear exam: bilateral intact tympanic membrane. Throat exam: grade I tonsil bilaterally. Neck examination: no neck masses. Facial rash, nasal and perinasal swelling and tenderness with palpation were noted. Lower limb: no deformity, no scar, no swelling. The plan in the clinic was to give nasal spray, order sinuses computed tomography (CT), follow CT result, and to refer to rheumatology and dermatology.