Nasal Septum Perforation Due To Desmopressin Spray: Case Report

Desmopressin, a synthetic vasopressin, is used to treat a variety of conditions, including bleeding disorder, diabetes insipidus, nocturnal enuresis, and uremia. It may be administered orally, sublingually, intravenously, or via intranasal spray. The report described the first published case of septal perforation related to desmopressin nasal spray use.

A 39-year-old female with a known septal perforation presented with symptoms of nasal crusting, epistaxis, and nasal pain. The patient had undergone a transnasal surgical procedure 9 years prior but postoperative nasal examinations revealed an intact, deviated septum. The patient developed diabetes insipidus which was treated with desmopressin nasal spray. Nasal crusting and bleeding developed after 5 years of spray use, and spray application crossing over to the contralateral nasal cavity was eventually noted by the patient. A perforation was diagnosed, and desmopressin spray use was discontinued. However, due to persistent polyuria and thirst inspite of administration of oral desmopressin, the use of the nasal spray was reinstated. A CT scan confirmed the diagnosis.

The posterior margin of the perforation was ulcerated and crusted with dried blood. Surgical closure was recommended for symptom treatment and to stop perforation progression.

Perforation closure was performed endonasally utilizing bilateral mucosal flaps. Mucosa from the undersurface of the left upper lateral cartilage was incorporated into the repair to ensure a complete, tension-free closure following flap advancement and suturing. The intraoperative and postoperative courses were uneventful. Mild septal crusting persisted. Intranasal desmopressin use was resumed 7 months postoperatively after instruction on proper usage. There was no evidence of reperforation one month later.

"Patients utilizing a medicated spray should be instructed on proper spray application. Rhinologic evaluation is indicated when nasal symptoms following onset of spray use persist after the spray is discontinued. Septal perforation treatment success is improved with an early diagnosis," the team of surgeons, led by Daniela A. Brake, of the department of Otolaryngology, concluded.

Reference:

Case Report, "Nasal Septal Perforation Due to Desmopressin Nasal Spray Use," published in Sage Journals.

DOI: https://doi.org/10.1177/01455613211026425