Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 35-year-old man with a history of adult-onset asthma has had nasal obstruction and smelling loss for 4 months. He also reports postnasal drainage, cough, rhinorrhea, and facial pressure. He has no history of asthma or allergies as a child. He also has no history of previous nasal or paranasal sinus surgery. His symptoms worsen after drinking certain beers and also after using ibuprofen or aspirin.
Over the past 4 months, he has been given three courses of antibiotics, including amoxicillin, azithromycin, and amoxicillin-clavulanate with minimal effect on his symptoms. He has used nasal steroid spray one spray twice a day for 2 months, with partial improvement in symptoms of nasal congestion. He has had two courses of methylprednisolone, which had a significant effect on his symptoms; however, the effect was transient.
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Cite this: Thomas S. Higgins. Beer, Ibuprofen Worsen Nasal Issues in a 35-Year-Old With Asthma - Medscape - Sep 15, 2022.