Nasal Vestibulitis in a 56-Year-Old Man with Type 2 Diabetes Mellitus: A Case Report

Abstract

Background: Nasal vestibulitis is a localized bacterial infection of the nasal vestibule, most commonly caused by Staphylococcus aureus. It is frequently associated with local trauma, including habitual nose picking, hair plucking, and nasal instrumentation. Patients with diabetes mellitus are at increased risk due to impaired host immune function. Although generally regarded as a mild infection, delayed diagnosis and inappropriate treatment may lead to severe complications, including facial cellulitis, abscess formation, and cavernous sinus thrombosis.

Case Presentation: A 56-year-old man with a history of type 2 diabetes mellitus presented with a five-day history of bilateral nasal pain and swelling, accompanied by tenderness over the nasal tip, nasal obstruction, and purulent nasal discharge. The patient had previously undergone nasogastric tube insertion during hospitalization. Physical examination revealed bilateral erythema and edema of the nasal vestibule with crust formation, while laboratory investigations demonstrated a normal leukocyte count. Based on the clinical findings, the patient was diagnosed with bilateral nasal vestibulitis and treated with intravenous ceftriaxone, intravenous methylprednisolone, topical gentamicin ointment, analgesics, and saline nasal irrigation. Marked clinical improvement was observed after six days of treatment, with complete resolution of symptoms and no local or systemic complications during follow-up.

Method: A systematic literature search was conducted using PubMed, Scopus, and Google Scholar. The search strategy combined controlled vocabulary (MeSH) and free-text terms for the principal concepts, including nasal vestibulitis, nasal vestibular furunculosis, Staphylococcus aureus, and diabetes mellitus. The search was restricted to studies involving human subjects, published between 2020 and 2025, and written in English or Indonesian. Data extracted from eligible studies included patient demographics, predisposing factors, clinical manifestations, microbiological findings, treatment modalities, and clinical outcomes. Five relevant case reports met the inclusion criteria and were included in the evidence synthesis.

Result: Conservative management consisting of systemic antibiotics, topical antibiotic ointment, corticosteroids, analgesics, and saline nasal irrigation resulted in rapid clinical improvement without complications. Bilateral edema, erythema, tenderness, and crusting of the nasal vestibule resolved completely after six days of treatment. At follow-up, the patient remained asymptomatic with complete resolution of inflammatory signs and no evidence of recurrence or progression to facial cellulitis or intracranial complications.

Conclusion: This case emphasizes the importance of early recognition and prompt treatment of nasal vestibulitis, particularly in patients with diabetes mellitus and a history of nasal instrumentation. Combined systemic and topical antimicrobial therapy provides favorable clinical outcomes and effectively prevents potentially life-threatening complications associated with infection within the facial "danger triangle."