PMC4541633_01
Ulcerated lesion noted on the flank of this patient.
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F1
On physical examination, the patient was noted to have a 2.0 x 3.0-cm ulcerative lesion with undermined edges over the left flank region (Fig. 1).
Nasal endoscopy demonstrating a near total septal perforation (arrows) and irregular tissue at the cribriform plate (*). The right and left middle turbinates are visible and appear normal (MT).
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F2
Nasal endoscopy showed near-total loss of the nasal septum with the exception of the most superior and inferior portions, and irregular soft tissue at the cribriform skull base as well as partial destruction of the inferior turbinates (Fig. 2).
Nasal endoscopy of the lower nasal cavity demonstrates and absent nasal septum with friable tissue and crusting. Both sets of inferior turbinates (IT) and middle turbinates (MT) are visible.
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F3
The nasal mucosa was edematous and friable, and dense crusting was noted throughout, most notably on the nasal floor (Fig. 3).
Biopsy of the irregular tissue revealed acute and chronic inflammation with necrosis and lymphocytic extravasation, without evidence of vasculitis, granuloma, or neoplasm.
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F4
These additional tests were negative, and, again, a histologic examination revealed the presence of dense acute and chronic inflammation as well as focal necrosis and focal lymphocyte extravasation but an absence of granuloma formation, malignancy, or vasculitis (Fig. 4).