Twenty-nine years of silence: a rare case report of long-term retained nasal coin presenting as rhinolithiasis in adulthood.

BACKGROUND: Nasal foreign bodies (FBs) are frequently encountered in pediatric patients; however, it is uncommon for FBs to remain undetected into adulthood. Long-retained FBs-especially metallic-can trigger chronic inflammation and granulation tissue formation which may subsequently lead to rhinolithiasis. Diagnosis is often delayed by embarrassment, vague symptoms, or misdiagnosis as chronic rhinosinusitis. In some cases, the foreign body may remain asymptomatic for many years, further complicating the diagnosis.

CASE DESCRIPTION: We describe an uncommon case of a 35-year-old man who presented with a persistent unilateral nasal discharge for the last year. He has a history of coin insertion into his left nostril at 6 years of age. This condition was asymptomatic for nearly three decades. Discharge stagnation led him to seek medical assistance when it became foul-smelling, dark brown, and blood-stained. Anterior and lateral skull X-rays showed left posterior nasal cavity well-circumscribed radio-opaque lesion. Endoscopic surgery under general anesthesia found the inferior turbinate harboring the calcified coin which was fragmented during extraction and saved in six pieces. Recovery following this procedure was smooth without complication.

CONCLUSIONS: This case highlights the need to pay attention to long-standing nasal FBs in adults with chronic unilateral nasal complaints. Timely imaging as well as prompt surgical intervention is necessary to prevent complications like rhinolithiasis and chronic sinusitis.