Adult Nasopharyngitis: A Challenging Clinical Entity

Background: Although infections of the nasopharynx are common in childhood due mainly to adenoid disease, nasopharyngitis in adults is not usually considered a diagnosis per se.

Case Report: A 40-year-old woman presented to the outpatient clinics with a long history of postnasal drip and pain in the nasopharynx and oropharynx. The patient had had several courses of antibiotics over the previous 2 years with minimal effect. On examination the nasopharynx was inflamed and a crust of thick mucopurulent discharge was sitting in the posterior wall of nasopharynx. The crust was sent for culture and cytological examination and the results were Serratia and S. aureaus. Sinus CT scan was unremarkable. Following proper antibiotic treatment the symptoms initially resolved for 1 month. Six weeks later the symptoms recurred with the same clinical findings in the nasopharynx and a negative swab. Symptoms resolved again with broad spectrum antibiotics. A new CT scan showed diffuse swelling in the nasopharynx and a biopsy was performed, which showed nonspecific inflammation. Symptoms recurred for a third time and a further culture showed Serratia, S. aureus, and E. coli, the latter being sensitive only to Meronem. This was prescribed in combination with Augmentin. Following this, our patient remains free from symptoms over the last 6 months.

Discussion and Conclusions: The term adult nasopharyngitis is not widely used and the literature on this subject is scarce. The symptoms can vary, but usually there is erythema and inflammation on nasopharyngoscopy and cultures are positive for bacteria. In our patient the recurrent infection and irritation of the area was attributed to the inhalations of detergents as this patient is a domestic cleaner. The combination of nasal douches, nasal steroid spray, and antibiotics resolved the symptoms.