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Nasal septal perforation associated with pyoderma gangrenosum.

McConnell B, Said MS, Ramakrishnan VR - Allergy Rhinol (Providence) (2015)

Bottom Line: Pyoderma gangrenosum (PG) is a skin condition characterized by necrotic ulcers and most commonly occurs on the legs in association with inflammatory bowel disease and rheumatoid arthritis; however, PG rarely involves the head and neck, and very rarely causes nasal septal perforation.Together with serologic and nonserologic testing, as well as clinical evaluation, we were able to rule out other causes of septal perforation including Wegener's granulomatosis, lymphoma, and vasculitis, and concluded that the cause of nasal septal perforation was most likely PG.Septal perforation etiology should include a complete history and physical to evaluate for systemic etiologies, including rare ones such as PG.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, University of Colorado, Aurora, Colorado, USA.

ABSTRACT

Background: Pyoderma gangrenosum (PG) is a skin condition characterized by necrotic ulcers and most commonly occurs on the legs in association with inflammatory bowel disease and rheumatoid arthritis; however, PG rarely involves the head and neck, and very rarely causes nasal septal perforation.

Objective: Here, we describe a case report of PG causing nasal septal perforation in a 71-year-old male with truncal lesions in the absence of either inflammatory bowel disease or autoimmune arthritis.

Methods: Case report with histologic description.

Results: Histology from nasal mucosal biopsies showed chronic inflammation and reactive change without evidence of malignancy. Together with serologic and nonserologic testing, as well as clinical evaluation, we were able to rule out other causes of septal perforation including Wegener's granulomatosis, lymphoma, and vasculitis, and concluded that the cause of nasal septal perforation was most likely PG.

Conclusion: Septal perforation etiology should include a complete history and physical to evaluate for systemic etiologies, including rare ones such as PG.

No MeSH data available.


Related in: MedlinePlus

Nasal endoscopy of the lower nasal cavity demonstrates and absent nasal septum with friable tissue and crusting. Both sets of inferior turbinates (IT) and middle turbinates (MT) are visible.
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Figure 3: Nasal endoscopy of the lower nasal cavity demonstrates and absent nasal septum with friable tissue and crusting. Both sets of inferior turbinates (IT) and middle turbinates (MT) are visible.

Mentions: On physical examination, the patient was noted to have a 2.0 × 3.0-cm ulcerative lesion with undermined edges over the left flank region (Fig. 1). External nasal examination showed poor tip support, and anterior rhinoscopy demonstrated a large septal perforation. Nasal endoscopy showed near-total loss of the nasal septum with the exception of the most superior and inferior portions, and irregular soft tissue at the cribriform skull base as well as partial destruction of the inferior turbinates (Fig. 2). The nasal mucosa was edematous and friable, and dense crusting was noted throughout, most notably on the nasal floor (Fig. 3). Previous pathology slides were obtained for repeated evaluation and additional immunostaining for CD56, EBER, Melan A, S-100, and MAA to explore additional causes of septal perforation. These additional tests were negative, and, again, a histologic examination revealed the presence of dense acute and chronic inflammation as well as focal necrosis and focal lymphocyte extravasation but an absence of granuloma formation, malignancy, or vasculitis (Fig. 4). Hemosiderin deposition was also noted.


Nasal septal perforation associated with pyoderma gangrenosum.

McConnell B, Said MS, Ramakrishnan VR - Allergy Rhinol (Providence) (2015)

Nasal endoscopy of the lower nasal cavity demonstrates and absent nasal septum with friable tissue and crusting. Both sets of inferior turbinates (IT) and middle turbinates (MT) are visible.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541633&req=5

Figure 3: Nasal endoscopy of the lower nasal cavity demonstrates and absent nasal septum with friable tissue and crusting. Both sets of inferior turbinates (IT) and middle turbinates (MT) are visible.
Mentions: On physical examination, the patient was noted to have a 2.0 × 3.0-cm ulcerative lesion with undermined edges over the left flank region (Fig. 1). External nasal examination showed poor tip support, and anterior rhinoscopy demonstrated a large septal perforation. Nasal endoscopy showed near-total loss of the nasal septum with the exception of the most superior and inferior portions, and irregular soft tissue at the cribriform skull base as well as partial destruction of the inferior turbinates (Fig. 2). The nasal mucosa was edematous and friable, and dense crusting was noted throughout, most notably on the nasal floor (Fig. 3). Previous pathology slides were obtained for repeated evaluation and additional immunostaining for CD56, EBER, Melan A, S-100, and MAA to explore additional causes of septal perforation. These additional tests were negative, and, again, a histologic examination revealed the presence of dense acute and chronic inflammation as well as focal necrosis and focal lymphocyte extravasation but an absence of granuloma formation, malignancy, or vasculitis (Fig. 4). Hemosiderin deposition was also noted.

Bottom Line: Pyoderma gangrenosum (PG) is a skin condition characterized by necrotic ulcers and most commonly occurs on the legs in association with inflammatory bowel disease and rheumatoid arthritis; however, PG rarely involves the head and neck, and very rarely causes nasal septal perforation.Together with serologic and nonserologic testing, as well as clinical evaluation, we were able to rule out other causes of septal perforation including Wegener's granulomatosis, lymphoma, and vasculitis, and concluded that the cause of nasal septal perforation was most likely PG.Septal perforation etiology should include a complete history and physical to evaluate for systemic etiologies, including rare ones such as PG.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, University of Colorado, Aurora, Colorado, USA.

ABSTRACT

Background: Pyoderma gangrenosum (PG) is a skin condition characterized by necrotic ulcers and most commonly occurs on the legs in association with inflammatory bowel disease and rheumatoid arthritis; however, PG rarely involves the head and neck, and very rarely causes nasal septal perforation.

Objective: Here, we describe a case report of PG causing nasal septal perforation in a 71-year-old male with truncal lesions in the absence of either inflammatory bowel disease or autoimmune arthritis.

Methods: Case report with histologic description.

Results: Histology from nasal mucosal biopsies showed chronic inflammation and reactive change without evidence of malignancy. Together with serologic and nonserologic testing, as well as clinical evaluation, we were able to rule out other causes of septal perforation including Wegener's granulomatosis, lymphoma, and vasculitis, and concluded that the cause of nasal septal perforation was most likely PG.

Conclusion: Septal perforation etiology should include a complete history and physical to evaluate for systemic etiologies, including rare ones such as PG.

No MeSH data available.


Related in: MedlinePlus