Eosinophilic angiocentric fibrosis of the sinonasal tract in a male patient with chronic bowel inflammation

Background: Eosinophilic angiocentric fibrosis (EAF) is an uncommon inflammatory fibrosing lesion involving the upper respiratory mucosa, occurring mainly in young to middle aged women (female/male ratio = 2:1). The etiology is unknown; however, several factors might play a role in the development of EAF. Among them are prior nasal trauma (in most of the reported cases nasal surgery had been performed a few years prior to diagnosis) and inflammatory or autoimmune etiology (suggested by the ratio and the fact that in many of the reported cases a history of nonspecific allergy was found). Methods: We report the first case of EAF affecting a male patient who also suffered from chronic inflammatory bowel disease and rheumatic fever. Results: The patient underwent a diagnostic biopsy of his nasal lesion via an open rhinoplasty approach, with the resulting diagnosis of EAF. Despite the fact that the literature does not show advantages to any specific therapy, the patient elected to remain under observation. During a two-year follow-up period, there is no evidence of progression of disease. Conclusion: The presence of concomitant rheumatoid arthritis and chronic inflammatory bowel disease in our patient, as well as the fact that nine previously reported cases of EAF had allergic/immune symptoms, raise the possibility that inflammatory or autoimmune factors may have a role in the development of this unusual pathological entity.