Investigations:
(1) Blood investigations for Anaemia and raised ESR.
(2)
X-ray: Chest, PNS, CT Scan paranasal sinuses if severe sinusitis.
(3)
Renal function tests: Reduced sinuses creatinine clearance.
(4)
Nasal Biopsy: It shows
-
a) Necrosis and ulceration of mucosa.
-
b) Epithelioid granuloma.
c) Necrotizing vasculitis involving small arteries or veins.
Medical treatment:
Systemic:
- Steroids: 40-60mg/kg/day.
- Cytotoxic drugs:(a) Azathioprine 3mg/kg/day.
(b) Cyclophosphamide 2mg/kg/day.
Local:
Glucose in Glycerin nasal drops.
Surgical:
Treatment of sinusitis by Functional Endoscopic Sinus Surgery (FESS).
If perforation of the nasal septum is there, then surgical repair is recommended by septal perforation repair by nasal flap or septal button.
If saddle nose deformity is there, then surgical repair is done by augmentation rhinoplasty.
Spread: To eyes, kidneys, joints, heart and CNS.
Complications:
- Opportunistic fungal infections.
- Cytotoxic drug.