We report the case of a 33-year-old man with a personal history of anxiety, who was treated with escitalopram 10 mg and alprazolam 0.5 mg. He had been an ex-smoker for 6 months.
He came to the Primary Care Emergency Department complaining of "asphyxia", shortness of breath and pharyngeal foreign body.
The examination showed good vesicular murmur without overlapping sounds, oxygen saturation 98 %.
Upon inspection of the pharynx, the patient presents a uvula with prolongation and thickened papillomatous lesions.
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The pathology is explained to the patient.
The evaluation is advised by your family doctor, who is referred to the otolaryngologist (ORL).
He was screened for other sexually transmitted diseases with negative results for syphilis infection, human immunodeficiency virus, herpes and hepatitis.
The ENT diagnosed left sinusonasal polyposis with bone base and deviation of the nasal septum, widening of the infundibulum of the maxillary sinus and uvula with papillomatous formation.
Surgery is performed and from Pathological Anatomy report an inverted papilloma in the nasal sinus and uvula lesion as squamous papilloma.
Currently the patient has improved markedly both by nasal symptoms to which he did not refer until reaching the ENT as by the sensation of foreign body.
In this particular case, it would be interesting to know that the patient does not maintain a good relationship with his family doctor because in his opinion he does not treat his anxious-depressive clinic well.
The patient usually goes to the doctor's office when he is out of bed or vacation; in fact, antidepressant and anxiolytic treatment was not initiated by his doctor, making it difficult to monitor his condition.
The patient did not comment on the congestion caused by nasal polyposis for the same reason.
The relationship you have with your family doctor also helps explain why you go to the emergency department for a visit that is not really acute.
We cannot rule out the fact that their symptoms have gone unnoticed by physicians in relation to anxiety.
