@article{Gonzales_2018, title={Lethal Midline Granuloma in a 15-Year-Old Girl: A Diagnostic Dilemma}, volume={33}, url={https://pjohns.pso-hns.org/index.php/pjohns/article/view/273}, DOI={10.32412/pjohns.v33i2.273}, abstractNote={<p><strong>Objective: </strong>To report a case of lethal midline granuloma and discuss the diagnostic and treatment dilemma, and management.</p> <p><strong>Methods</strong></p> <p>            <strong>Design:</strong>           Case Report</p> <p>            <strong>Setting:</strong>           Tertiary Government Hospital</p> <p>            <strong>Patient:</strong>           One</p> <p><strong>Results: </strong>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.</p> <p><strong>Conclusion: </strong>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.</p> <p><strong> </strong></p> <p><strong>Keywords: </strong><em>Granuloma, lethal midline<strong>; </strong>Lymphoma, extranodal NK-T-cell</em></p>}, number={2}, journal={Philippine Journal of Otolaryngology Head and Neck Surgery}, author={Gonzales, Ian Christian A.}, year={2018}, month={Nov.}, pages={37–40} }