The nasal mucosa may appear as a granular, friable crust

Introduction The nasal mucosa can be granulated and fragile. It is one of the symptoms of allergic vasculitis. The main symptoms of respiratory system manifestations of allergic vasculitis and granulomatosis are nasal congestion, discharge of purulent or bloody secretions, and obstruction of breathing when the polyps are severe. The onset of allergic vasculitis can be anxious to slow down the body's more common symptoms including fever, fatigue, fatigue, etc., local symptoms are mainly skin symptoms, a small number of patients have skin involvement, such as joints, kidneys, lungs, digestive system.

Cause

Caused by allergic vasculitis and granulomatosis. Allergic vasculitis is one of the most common vasculitis. Histopathological examination revealed fibrinous necrosis of the vessel wall and extensive neutrophil infiltration around the vessel.

an examination

Related inspection

Nasal endoscopy nasopharynx MRI

So far, the diagnosis of allergic granuloma is mainly based on the combination of clinical and pathological. Most patients have a history of middle-aged disease and have a history of asthma for several years. In addition to asthma, such as allergic rhinitis and eosinophilia, as well as other systemic diseases such as single or multiple mononeuritis, pulmonary infiltration, myocardial lesions, etc. should consider the possibility of Churg-Strauss syndrome. If there are symptoms such as asthma, eosinophilia and polyneuritis, and high titer anti-myeloperoxidase antibody or perinuclear anti-neutrophil cytoplasmic antibody in serum, Churg is highly suggested. - Diagnosis of Strauss syndrome.

Laboratory inspection:

(1) Blood test: blood eosinophils often increase, white blood cell count can be increased, erythrocyte sedimentation rate increases rapidly, hyperglobulinemia and ADP and prostaglandin increase, generally no anemia platelet count is normal, clotting time normal. There is IgG-IgM cryoglobulinemia, laboratory tests show that hyper-gammaemia and hypo-complementemia RF and HBsAg can be positive.

(2) urine test: there may be protein, red blood cells, white blood cells and casts. In severe cases, there may be proteinuria in the range of nephrotic syndrome, and there may be an increase in urea nitrogen and creatinine when renal function is reduced.

(3) routine examination of feces: some patients can see parasite eggs and red blood cells, occult blood test can be positive.

(4) Bone marrow: normal bone marrow, eosinophils

(5) Positive capillary fragility test.

Differential diagnosis

Nasal mucosal ulcers: The main feature of nasal mucosal ulcers is nose bleeding, which can sometimes be severe. Traditional Chinese medicine has traditionally referred to the ulceration of the nasal mucosa or the sore surface of the incision as the ulcer, which is different from the meaning of the sore surface which is lack of healing tendency in modern medicine. Traditional Chinese medicine nasal mucosal ulcers are mostly deficiency syndrome.

Swelling of the nasal mucosa: The stability of the environment inside the nasal mucosa, in addition to relying on neuromodulation, also undergoes regulation of endocrine hormones. The nasal mucosa is rich in various components of the vascular bed and mucosal immunity. At the level of the neuroendocrine immune network, changes in the levels of endocrine hormones can affect the nasal mucosa through blood circulation. In patients with clinically common female rhinitis, the symptoms are significantly aggravated in the premenstrual period, and the symptoms are alleviated or disappeared after the menstrual period. Menstrual and gestational women have hypertrophy of the nasal mucosa and dilated glands. The result of the above changes can produce respiratory mucosal immune or non-immune inflammation leading to the formation of high reactivity of the nasal mucosa, thereby causing rhinitis symptoms such as nasal congestion, runny nose, itchy nose, and sneezing. In addition, prostaglandins can inhibit the production of antibodies by B cells and inhibit the phagocytic function of macrophages. At the same time, prostaglandins as an inflammatory factor can cause vasodilatation in the onset of rhinitis and aggravate the degree of inflammatory response. In the nasal mucosa of patients with allergic rhinitis, the prostaglandin receptors also increase, resulting in dilated blood vessels in the nasal mucosa, nasal congestion and corresponding nasal congestion and hypersensitivity.

Nasal mucosa and turbinate atrophy: atrophic rhinitis is a chronic disease of the nasal mucosa and bone atrophy, accompanied by strange smelly, also known as stinky nose. There are more young women. The main pathological change is occlusive endocarditis, which causes atrophy of the nasal mucosa gland, periosteum and bone.

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