Is acne associated with sinusitis

Abstract Rationale Proprionibacterium acne is a common organism contributing to the pustular lesions of acne vulgaris. However, chronic sinusitis caused by P. acne is rare. Case report A 51 year old, female, was referred to the Allergy & Immunology Clinic for evaluation of the cause of chronic sinusitis. The symptoms suggestive of sinusitis started around the age of 20 years when she had severe acne vulgaris. She had been on multiple antibiotics but claimed doxycycline not only helped her acne but also partially improved symptoms of sinusitis. Result Progressive worsening of sinusitis symptoms led to endoscopic sinus surgery twice in the past 2 years. PAS staining of material obtained from the second maxillary sinus revealed noninvasive branching septal hyphae, however fungal culture revealed a non-sporulating, unidentified mold not resembling any of the known human pathogens isolated. No allergic mucin was seen. RAST performed for various inhalants including fungi was negative and Ig E level was 9 KU/L. The quantitative immunoglobulins IgG, M, A were normal. The Pneumococcal antibody serotype titers significantly increased after Pneumococcal Vaccine. The culture performed on the materials obtained during sinus surgery grew P. acne . Treatment with doxycycline has been resumed with significant clinical improvement. Conclusion It is likely that digital transmission of P. acne from skin lesions to nose and sinuses could have contributed to chronic sinusitis. Whereas this patient might have had fungal infection, the contribution of P. acne in the causation of chronic sinusitis appears to be intriguing.