Mohammed Abrahim, Nour Abdelaziz
Facial erysipelas is an uncommon but potentially serious manifestation of rhinosinusitis, as involvement of the facial "danger triangle" carries the risk of orbital and intracranial complications. Saline nasal irrigation devices are widely recommended as nonprescription, over-the-counter adjunctive therapy for the symptomatic management of sinonasal disease and are generally considered safe. We report the case of a 60-year-old man who developed rapidly progressive centrofacial erysipelas after one week of using a commercially available pressurized seawater nasal irrigation device for an acute exacerbation of chronic rhinosinusitis. To our knowledge, this is the first reported temporal association between the use of a pressurized nasal irrigation device (PNID) and facial erysipelas. Although causality cannot be inferred from a single case, several biologically plausible mechanisms warrant consideration. This report highlights facial erysipelas as a rare cutaneous manifestation of complicated rhinosinusitis and underscores the importance of obtaining a detailed history of PNID use. Further studies are needed to clarify whether this observed association is causal or incidental and to better define the safety of PNIDs in patients with suspected bacterial rhinosinusitis.