Drinking Beer Worsens Nasal Symptoms in a 35-Year-Old Man

Thomas S. Higgins, Jr, MD, MSPH


March 12, 2020

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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.

Physical Examination and Workup

Upon physical examination, the patient is alert, oriented, and in no acute distress. Vital signs include an oral temperature of 97.9 °F (36.6 °C), a blood pressure of 115/83 mm Hg, a heart rate of 65 beats/min, and a respiratory rate of 14 breaths/min. Head, ear, throat, and neck examination findings are unremarkable. Nasal examination shows large nasal polyps that fill the nasal cavities bilaterally, large inferior turbinates, and clear mucoid secretions (Figure 1). No crusting or scarring is observed.

Figure 1.

Auscultation of the lungs demonstrates mild expiratory wheezing bilaterally. Allergy skin testing reveals no reactions. Spirometry revealed a forced expiratory volume in the first second of expiration (FEV1) of 75%. Chest radiography findings are normal.

CT scan of the paranasal sinuses reveals severe pansinusitis with complete to near-complete opacification of the paranasal sinus cavities and nasal cavities (Figure 2).

Figure 2.

Mild osteitis of the paranasal sinus bone is observed, with no dehiscence of the lamina papyracea or skull base. Surgical pathology of the lesion reveals findings similar to the image shown below (Figure 3).

Figure 3.


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