trimethoprim--sulfamethoxazole-drug-combination and Paranasal-Sinus-Diseases

A diagnosis of Wegener granulomatosis requires granulomatous manifestations in the respiratory tract. With the increasing use of antineutrophil cytoplasmic autoantibodies as a diagnostic tool, Wegener granulomatosis is diagnosed earlier than in the past, and not infrequently when only ear, nose and throat manifestations are present, placing the otorhinolaryngologist in a central role in diagnosis and management. Diagnostic biopsies should be obtained from active lesions in the nose and paranasal sinuses and concomitant infection should be identified. Because of the apparent relation between infection and activation of disease, the management of infections-especially those due to Staphylococcus aureus-requires special attention. The increasing numbers of early cases identified warrants further investigations of whether less toxic treatment regimens will be of advantage in such cases. Medical and surgical treatment of the acute and chronic manifestations presents specific problems because of altered immune competence, prevalent superinfection, and tissue destruction, and is therefore best taken care of by specially dedicated otorhinolaryngologists.

Topics: Ear Diseases; Granulomatosis with Polyangiitis; Humans; Laryngeal Diseases; Mouth Diseases; Nasal Mucosa; Nose Diseases; Paranasal Sinus Diseases; Salivary Gland Diseases; Staphylococcal Infections; Tracheal Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

Topics: Anti-Infective Agents; Autoantibodies; Autoimmune Diseases; Humans; Male; Middle Aged; Paranasal Sinus Diseases; Peroxidase; Sweet Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Female; Granulomatosis with Polyangiitis; Humans; Paranasal Sinus Diseases; Radiography; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Wegener's granulomatosis has traditionally been treated with steroids and cyclophosphamide. However, sulfamethoxazole-trimethoprim has been shown to be effective. We used it to treat a patient with this disease who had pulmonary infiltrates, sinusitis, and evidence of renal disease manifested by hematuria and red cell casts. After two months of therapy with sulfamethoxazole-trimethoprim, his hematologic and radiologic values returned to normal.

Topics: Anti-Infective Agents; Drug Administration Schedule; Drug Combinations; Granulomatosis with Polyangiitis; Humans; Male; Middle Aged; Paranasal Sinus Diseases; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination