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Perforation of the nasal septum and palate due to Wegener's granulomatosis.

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AKHMETSHINA ET AL
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DOI 10.1002/art.23502
Clinical Images: Perforation of the nasal septum and palate due to Wegener’s granulomatosis
The patient, a 26-year-old woman, was admitted to our hospital with fever and nasal discharge. She had an 18-month history of nasal
discharge and nasal stiffness. Paranasal computed tomography (CT) performed at another hospital revealed increased density in the
maxillary and ethmoid sinuses, and loss of conchae. Nasal biopsy showed a chronic inflammatory process with giant cells, necrosis,
and ulceration on epithelial cells. The patient had been prescribed methylprednisolone (MP) and cyclophosphamide (CYC) by
another physician, but did not take her medications regularly. She was referred to our clinic because of palatal destruction. On
examination, saddlenose deformity (A) associated with destruction of the nasal septum as well as palatal destruction (B) were found.
The patient was positive for classic antineutrophil cytoplasmic antibody (cANCA). Findings of urinalysis and high-resolution CT of
the lung were normal. MP (40 mg/day), CYC (50–100 mg/day), and trimethoprim/sulfamethoxazole were given. After 6 months,
results of testing for cANCA were negative. Nasal secretion and signs of inflammation around the palatal hole subsided. Palatal
destruction is seen rarely in the course of Wegener’s granulomatosis (1–3). Delayed treatment in this case may be an explanation
for the destructive lesions.
1. Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD,
et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med
1992;116:488–98.
2. Loke YK, Tan MH. An unusual case of Wegener’s granulomatosis. Med J
Malaysia 1998;53:107–9.
3. Matsumura T, Sato-Matsumura KC, Ota M, Yokota T, Arita K, Kodama K,
et al. Two cases of pyoderma gangrenosum complicated with nasal septal
perforation. Br J Dermatol 1999;141:1133–5.
Timuçin Kasifoglu, MD
Dondu Cansu, MD
Cengiz Korkmaz, MD
Eskişehir Osmangazi University Medical Faculty
Eskişehir, Turkey
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septum, perforating, granulomatosis, due, nasal, wegener, palate
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