Epstein-Barr virus-mild acquired immune deficiency syndrome (EBV-MAIDS) in postsurgical sinusitis.
BACKGROUND
Functional endoscopic sinus surgery has remarkably improved the treatment of chronic rhinosinusitis patients. Computed tomography, endoscopic optical instrumentation, powered microdebriders, and computer-assisted surgery have surmounted the technical problems of obstructive sinusitis care. Most experienced practitioners achieve reported success rates of 85-95% among their surgical patients. However, the 5-15% refractory patients reported by all rhinologic surgeons leave an exasperating and perplexing group who, despite appropriate mechanical corrections, continue to experience debilitating rhinosinusitis episodes requiring repeated oral, nebulized, or intravenous antibiotics, and in some cases, antifungal therapy.


METHODS
Recent studies have indicated that host immune response mechanisms may be altered in the paranasal sinus tissues of sinusitis patients. After years of observation, it was felt that these difficult patients may suffer from a common thread of significant partial immunocompromise. Drawing on military experience of treating immunoimmature populations prone to Epstein-Barr virus (EBV) infectious mononucleosis and the consequent postmononucleosis syndrome, it was sought to screen disabled refractory postsurgical sinusitis patients for this factor and treat them with long-standing military protocols for the immunoimmature populations dispatched to third-world combat conditions.


RESULTS
Treatment of Epstein-Barr Virus-Mild Acquired Immune Deficiency Syndrome consisted of periodic intramuscular serum immune globulin injections (immunomodulator therapy), after obtaining their thorough written informed consent, which produced substantial and sustainable improvement in patient's quality of life.


CONCLUSIONS
Detection of mild-to-moderate acquired immune deficiency among postsurgical rhinosinusitis patients can lead to successful treatment and an improved quality of life.
Toffel
Paul H
PH
Department of Otolaryngology-Head and Neck Surgery, University of Southern California School of Medicine, and the United States Naval Medical Corps, Glendale, California 91208, USA.
Christensen
Joshua
J
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D000914:Antibodies, Viral / Q000097:blood*; D004724:Endoscopy / Q000379:methods; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007244:Infectious Mononucleosis / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000601:surgery
D000914:Antibodies, Viral; D007074:Immunoglobulin G