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

• Main Author: Ian Christian A. Gonzales
• Format: Article
• Language: English
• Published: Philippine Society of Otolaryngology-Head and Neck Surgery, Inc. 2018-11-01
• Series: Philippine Journal of Otolaryngology Head and Neck Surgery
• Subjects: Granuloma, lethal midline; Lymphoma, extranodal NK-T-cell
• Online Access: https://pjohns.pso-hns.org/index.php/pjohns/article/view/273
• ISSN: 1908-4889; 2094-1501

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