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Abstract ID: 24-119
Acute Dacryocystitis, Ethmoiditis and Frontal Sinusitis in Graft-Versus-Host Disease
Mari Goto
Purpose
Graft-versus-host disease (GVHD) require long term administration of steroid and immunosuppressants, resulting in susceptibility to infection. We present a case of GVHD complicated with acute dacryocystitis, ethmoiditis and frontal sinusitis.
Methods
A 62-year-old female presented with injection, swelling and pain around her right eye accompanied by discharge for 2 days. She had undergone bone marrow transplantation for myelodysplastic syndrome 9 years before and had been treated for GVHD with prednisolone 10mg/day and tacrolimus hydrate 0.4mg/day. She was also treated for dry eye with fluorometholone eye drops and rebamipide ophthalmic suspension (Mucosta Ophthalmic Suspension UD 2%; Otsuka Pharmaceutical Co., Tokyo) 3-4 times/day. Bacterial culture of pus from right lacrimal sac was positive for Morganelli morganii. Magnetic Resonance Imaging (MRI) revealed enlarged right lacrimal sac with contrast enhancement around the sac, accompanied by inflammation in ethmoid and frontal sinus. Computed Tomography (CT) showed enlarged and obstructed right lacrimal duct. She was diagnosed as right acute dacryocystitis complicated with ethmoiditis and frontal sinusitis. Ceftriaxone sodium hydrate 2g/day was administered intravenously for one week with no clinical improvement. Right dacryocystectomy was performed. Lacrimal sac was filled with pus and a 5x10mm whitish concrement. Clinical symptoms improved after surgery. MRI taken 2 months postoperatively proved resolution of ethmoiditis and frontal sinusitis. Analysis using infrared spectrophotometer and liquid chromatograph showed that 44% of the concrement composed of rebamipide.
Results
Antibiotics had limited effect in controlling acute dacryocystitis in immunocompromised state. Early dacryocystectomy proved effective and resulted in resolution of sinusitis. Rebamipide, a mucin secretagogue known to be effective for GVHD-associated dry eye, may form concrements in lacrimal sac.
Conclusion
Acute dacryocystitis in GVHD may worsen rapidly and complicate sinusitis.
Additional Authors
Tatsushi Kawaguchi – Tokyo Metropolitan Komagome Hospital
Noriko Ozaki – Tokyo Metropolitan Komagome Hospital