Managing Frontal Sinusitis from Systemic Inflammatory Disease

  • Lester E. Mertz
  • Rohit Divekar
  • Matthew A. Rank


In this chapter, we outline the systemic diseases that can be encountered in patients with chronic frontal sinusitis, starting with identification of clinical patterns. Next, we compare and contrast the various conditions that may be associated with chronic frontal sinusitis, including allergic fungal sinusitis, aspirin-exacerbated respiratory disease, common variable immune deficiency, eosinophilic granulomatosis with polyangiitis, granulomatosis with polyangiitis, HIV, IgG4-related disease, odontogenic sinusitis, cystic fibrosis, primary ciliary dyskinesia, sarcoidosis, and cocaine-induced midline destructive lesions. We discuss examination features as well as laboratory and radiographic findings. Finally, we review in detail the management options specific to the identified systemic diseases.


Allergic fungal sinusitis Aspirin-exacerbated respiratory disease Common variable immune deficiency Eosinophilic granulomatosis with polyangiitis Granulomatosis with polyangiitis HIV IgG4-related disease Odontogenic sinusitis Cystic fibrosis Primary ciliary dyskinesia Sarcoidosis Cocaine-induced midline destructive lesions 



Angiotensin-converting enzyme


American College of Rheumatology


Aspirin-exacerbated respiratory disease


Allergic fungal sinusitis


Anti-neutrophil cytoplasmic antibody

Anti-MPO ab

Anti-myeloperoxidase antibody

Anti-PR3 ab

Anti-proteinase 3 antibody


Birmingham Vasculitis Activity Score


BVAS for Wegener’s granulomatosis (GPA)


Cytoplasmic anti-neutrophil cytoplasmic antibody


Cystic fibrosis


Chapel Hill Consensus Conference


Cocaine-induced midline destructive lesions syndrome


C-reactive protein


Chronic rhinosinusitis


Chronic rhinosinusitis without (sans) nasal polyps


Chronic rhinosinusitis with nasal polyps


Common variable immune deficiency


Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)


European Medical Agency


Ear, nose, and throat


Erythrocyte sedimentation rate


European League Against Rheumatism


Granulomatosis with polyangiitis (Wegener’s granulomatosis)


Head, eye, ear, nose, and throat


Human immunodeficiency virus




IgG4-related disease


Microscopic polyangiitis


Perinuclear anti-neutrophil cytoplasmic antibody


Primary ciliary dyskinesia




Vasculitis damage index



We thank Drs. Rodrigo Cartin-Ceba and Devyani Lal, both from Mayo Clinic Arizona, for their input on this chapter.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Lester E. Mertz
    • 1
  • Rohit Divekar
    • 2
  • Matthew A. Rank
    • 3
  1. 1.Division of Rheumatology, Department of MedicineMayo ClinicScottsdaleUSA
  2. 2.Division of Allergic DiseasesMayo ClinicRochesterUSA
  3. 3.Division of Allergy, Asthma, and Clinical ImmunologyMayo ClinicScottsdaleUSA

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