NARESMA in a pediatric patient: Early cytological detection to prevent CRSwNP progression

A 13-year-old girl presented with persistent nasal obstruction and rhinorrhea unresponsive to standard antihistamines. Nasal cytology revealed abundant eosinophils and degranulated mast cells, consistent with NARESMA—a mixed non-allergic rhinitis subtype. A CT scan showed lobulated, pseudopolypoid mucosal thickening in both maxillary sinuses, suggestive of early mucosal remodeling. Given the established link between NARESMA and CRSwNP, early identification prompted preventive topical corticosteroid treatment. This case highlights the importance of nasal cytology in pediatric patients to identify type 2 inflammation early and prevent progression to more severe disease.