Persistent Rhinitis Following Viral Illness in Young Adult

Case at a Glance

A 23-year-old female presents with persistent rhinorrhea, nasal pruritus, and frequent sneezing that began following a viral upper respiratory infection 4 months prior. Symptoms have not resolved despite cessation of potential irritants.

Patient's Story

The patient reports developing an upper respiratory illness approximately 4 months ago from which she recovered, except for persistent nasal symptoms. She describes continuous rhinorrhea with significant internal nasal itching and frequent sneezing episodes that are disrupting her sleep and daily activities. These symptoms represent a new pattern for her, as she previously had no significant nasal complaints. The patient has a smoking history of mixed cannabis and tobacco use initiated 6 months ago, with frequency of several times daily. She attempted smoking cessation for 1-2 months without symptom improvement. She has a known history of mild dust sensitivity and a minor deviated nasal septum that has not required surgical intervention.

Initial Assessment

Patient presents with post-infectious rhinitis symptoms persisting for 4 months. Physical examination would likely reveal inflamed nasal mucosa with clear discharge. The patient's history of mild allergic rhinitis and structural nasal abnormality (deviated septum) may be contributing factors to symptom persistence.

The Diagnostic Journey

Differential diagnosis includes post-viral rhinitis, allergic rhinitis exacerbation, chronic rhinosinusitis, and irritant-induced rhinitis. The temporal relationship to viral illness suggests post-infectious etiology, though the duration raises concern for development of chronic rhinitis. Environmental triggers and smoking history require consideration.

Final Diagnosis

Post-viral chronic rhinitis with possible allergic component, complicated by mild deviated septum and environmental irritant exposure.

Treatment Plan

Initiated topical intranasal corticosteroid therapy (fluticasone or mometasone) for anti-inflammatory effect. Recommended complete smoking cessation despite previous unsuccessful attempt. Environmental control measures including dust mitigation and air filtration. Patient counseled on proper nasal spray technique and expected timeline for improvement.

Outcome and Follow-up

Patient advised to continue treatment for 4-6 weeks with reassessment. Plans for specialist evaluation in home country if symptoms persist. Emphasis placed on smoking cessation as both therapeutic and preventive measure for long-term respiratory health.