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Images of Memorable Cases: Case 122

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk. E-mail the authorsEdited By: Frederick Moody

http://rup.rice.edu/memcases-button.jpg

Case_122-pres1-1.jpg

This 61-year-old man presented with a four-month history of progressively destructive disease of his mid-face. He had no associated signs or symptoms, and his oral cavity and facial bones were not involved. His nasal septum, however, was perforated.

The term used at the time of the patient’s presentation (1965) to describe inflammatory destructive lesions of unknown cause. With the sophisticated testing available today, however, most of these patients are now known to have lymphoma or Wegener’s granulomatosis. Other documented causes of this “midline granuloma” syndrome include cocaine abuse; trauma; certain bacterial, fungal, and parasitic infections; malignant neoplasms; connective tissue diseases; sarcoidosis; and hypersensitivity angiitis.

The lesion shown healed completely after local radiotherapy (image below), and the patient remained free of disease during a three-year follow-up.

Case_122-diag1-1.jpg

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