Lethal Midline Granuloma in a 15-Year-Old Girl: A Diagnostic Dilemma

  • Ian Christian A. Gonzales Cagayan de Oro Consortium of Otorhinolaryngology Head and Neck Surgery Northern Mindanao Medical Center
Keywords: Granuloma, lethal midline; Lymphoma, extranodal NK-T-cell

Abstract

Objective: To report a case of lethal midline granuloma and discuss the diagnostic and treatment dilemma, and management.

Methods

            Design:           Case Report

            Setting:           Tertiary Government Hospital

            Patient:           One

Results: A 15-year-old girl under treatment for pulmonary tuberculosis presented to the Emergency Room for epistaxis and a nasopalatine lesion. She was managed as a case of nasopalatine osteomyelitis for one month and discharged on antibiotics. She returned due to bleeding after being lost to follow up for 3 more months. Hemostasis, debridement and biopsy yielded atypical cells, possibly lymphoma. Immunohistochemistry confirmed the diagnosis of NK-cell lymphoma. Unfortunately, she expired prior to initiation of chemotherapy.

Conclusion: Clinicians must have a high index of suspicion for lethal midline granuloma in chronic, non-healing midline lesions. Multiple biopsies confirm the diagnosis, and earlier initiation of treatment may improve prognosis.

 

Keywords: Granuloma, lethal midline; Lymphoma, extranodal NK-T-cell

Published
2018-11-13
How to Cite
1.
Gonzales IC. Lethal Midline Granuloma in a 15-Year-Old Girl: A Diagnostic Dilemma. PJOHNS [Internet]. 13Nov.2018 [cited 13Dec.2018];33(2):37-0. Available from: https://pjohns.pso-hns.org/index.php/pjohns/article/view/273