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.