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

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

Keywords

• Granuloma, lethal midline; Lymphoma, extranodal NK-T-cell