Multiple Sclerosis Masquerading as Post Septorhinoplasty Complication: A Case Report

This is a case report of a young woman, who after a successful septorhinoplasty procedure, sustained repeated nasal trauma with a subsequent diagnosis of multiple sclerosis (MS) at a large tertiary hospital in Riyadh, Saudi Arabia. A 24-year-old woman with a history of childhood trauma presented with difficulty in breathing and dissatisfaction with her nasal appearance. After a successful and uneventful septorhinoplasty, she required numerous hospital admissions due to multiple episodes of blunt nasal trauma, culminating in clear nasal discharge and neurological symptoms, including dizziness, right-sided paresthesia and difficulty walking. Cerebrospinal fluid (CSF) leak was ruled out by CT brain; however, magnetic resonance imaging (MRI) of the brain and spinal cord showed demyelinating areas in the brain and cervical region of the spinal cord. CSF examination revealed the presence of oligoclonal bands. A neurologist confirmed the diagnosis of MS and initiated treatment, which was well tolerated. The patient is in remission with mild paresthesia in the right hand. Despite the repeated nasal trauma, the septorhinoplasty procedure had an excellent outcome. In conclusion, repeated nasal trauma, especially in the early postoperative period, in addition to procedure failure, may also point to the presence of an uncommon underlying neurological disorder, hitherto undiagnosed. It is therefore important to have an open mind when it comes to the differential diagnosis in such unusual scenarios. In addition, while investigating recurrent nasal trauma, it is extremely important to keep in mind rare neurological conditions, especially in younger patients.