A 45-Year-Old Remote Worker With Chronic Sinus Symptoms

Heidi Moawad, MD


August 04, 2023

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.


For 9 months, an otherwise healthy 45-year-old man has experienced almost constant sinus congestion, runny nose, occasional coughing, and headaches several times per week. The headaches are mild, occur at any time of the day without a consistent pattern, and affect the front and sides of his head. He says that he usually takes two 325-mg tablets of aspirin when the headaches become annoying, and the pain always resolves.

Initially, he thought he had a cold. When the symptoms did not improve after a week, he took an at-home COVID-19 test, which was negative. Because no one he knew had COVID at the time, he was satisfied with those results.

He has had no appetite changes, weight changes, sleeping disturbances, fatigue, mood changes, pain (besides the headaches), weakness, or paresthesias. He lives with his wife and two school-aged children and says that his life is not stressful. The patient works from home as a project manager and has been at the same company for 12 years. He generally takes his children to doctor or dentist appointments or brings the family pets to the veterinarian as needed during the day.

For years, he has been gardening and cutting the grass, and he has not made any changes in the type of products he uses or in the process of caring for his garden and lawn. He has considered whether his congestion could be related to pollen or lawn care products because some neighbors have pollen allergies. He started wearing a face mask while mowing the lawn. The mask did not help, and his symptoms have been consistent throughout the summer, fall, and winter and now heading into spring.

He regularly exercises indoors and jogs outdoors, and he has not experienced exercise intolerance, shortness of breath, or wheezing. He has no family history of allergies, respiratory disease, immune disorders, or cancer.


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