Tumour necrosis factor inhibitor-associated sinusitis.

Area of Science:

• Immunology
• Otolaryngology
• Pharmacology

Background:

• Tumor necrosis factor (TNF) inhibitors are increasingly used to treat inflammatory diseases.
• The potential side effects of TNF inhibitors are being actively investigated.
• Chronic sinusitis is a common condition with various etiologies.

Observation:

• A retrospective review identified five patients who developed chronic sinusitis after initiating TNF inhibitor therapy.
• The incidence of refractory sinusitis associated with TNF inhibitors was approximately 2% in the reviewed patient cohort.
• Etanercept and infliximab were the TNF inhibitors used by the affected patients.

Findings:

• Maxillary sinusitis was the most common presentation.
• Pseudomonas aeruginosa was the predominant pathogen identified in sinus cultures.
• Treatment outcomes varied, with some patients responding to antibiotics while others required cessation of TNF inhibitors or surgical intervention.

Implications:

• Chronic sinusitis associated with TNF inhibitors may represent a distinct clinical entity.
• Increased awareness and recognition of this condition are crucial given the expanding use of TNF inhibitors.
• Further research is warranted to elucidate the pathogenesis and optimize management strategies for this specific type of sinusitis.