Acute exacerbation of chronic maxillary sinusitis during therapy with nafarelin nasal spray

ObjectiveTo describe a case of acute exacerbation of chronic bilateral maxillary sinusitis during therapy with nafarelin nasal spray for chronic pelvic pain and suspected adenomyosis uteri in a patient of 34 years.DesignCase report.InterventionsIn the follicular stage of the cycle a diagnostic laparoscopy was carried out because of unexplained pelvic pain for 2 years with biopsy of the pelvic peritoneum and of the uterine fundus was done, revealing no pathology. One and a half years ago the patient already had a diagnostic laparoscopy for the same reason without pathological findings. Vaginal ultrasound showed minor signs of adenomyosis uteri (irregular structure of the myometrium with small cysts). One week after the operation, a therapy with nafarelin nasal spray was initiated in order to induce a hypoestrogenic state. Fourteen days later the therapy had to be stopped because of acute exacerbation of chronic maxillary sinusitis and Caldwell Luc operation and turbinoplastic was performed.OutcomeResolution of the acute maxillary sinusitis after operative intervention and termination of the above-mentioned medication, resolution of pelvic pain after therapy with leuprolide after 4 weeks.ConclusionsTo our knowledge, this is the first report of an acute exacerbation of a chronic maxillary sinusitis during the administration of nafarelin nasal spray. Gynecologists prescribing nasal sprays should ask their patients about symptoms of chronic sinusitis. Patients with a history of sinusitis should visit an ear, nose and throat (ENT) specialist before initiating therapy with nasal sprays; alternatively, drugs with a different formulation should be used for down-regulation of the ovarian function in order to avoid this complication.