Wegener′s disease |
Septal crusting, perforation, chronic sinusitis, “saddle deformity”
(+) c-ANCA
Biopsy: granuloma, vasculitis CXR; urinalysis important |
Rheumatology consult Systemic steroids, cyclophosphamide, methotrexate, or trimethoprim–sulfamethoxazole |
Sarcoidosis |
Elevated ACE level
Hilar adenopathy on CXR
Nasal edema, crusting, pain, obstruction |
Systemic steroids |
Syphilis |
(+) VDRL or RPR, FTA-ABS
Nasal erosion at mucocutaneous junction, mucus, scabbing, obstruction, rarely septal smooth mass or perforation |
Benzathine penicillin parenteral, or tetracycline |
Rhinoscleroma |
Africa, Central and South America travel
Catarrhal, atrophic, granulomatous, fibrotic stages
Biopsy: Mikulicz cells with intracellular Gram (–) organism |
Débridement |
Rhinosporidiosis |
Sri Lanka, southern India Nasal obstruction, rhinorrhea, epistaxis, tumor-like nasal lesions
Light microscopy demonstrates organism, Rhinosporidium seeberi |
Surgical débridement
Cauterization of margins
Steroid injections for recurrence |
Churg-Strauss′s disease |
Asthma, sinusitis, eosinophilia > 10%, histologically proven vasculitis, mononeuritis multiplex |
Systemic steroids
Cyclophosphamide
Consider sinus surgery for persistent disease |
Relapsing polychondritis |
Three or more of the following: bilateral auricular chondritis, seronegative arthritis, nasal chondritis, ocular inflammation, audiovestibular injury
May involve larynx
Elevated ESR, (+) immune complex deposition on biopsy |
Systemic steroids
Cyclophosphamide, azathioprine, methotrexate, dapsone considered |
Lethal midline granuloma |
Now considered to be angiocentric T-cell lymphoma Destructive midline nasal lesion |
Radiotherapy |
