Perforation of nasal septum in rheumatic diseases

Abstract

Perforation of the nasal septum was noted in 12 patients with rheumatic disease, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), and mixed connective tissue disease (MCTD). Biopsies were taken from the rim of the perforation in 7 of the 12 and revealed no vasculitis, immunoglobulin deposition, or consistent abnormality. Nasal septal perforation is an occassional finding in rheumatic disease and the cause is unknown.

Nasal manifestations of systemic illnesses

“…The nasal mucosa shows several changes, such as goblet cell hyperplasia, loss of cilia, and increased serous glandular activity without mucous elements [23].…”

Aspergillosis of the maxillary sinus in chronic myelomonocytic leukaemia

“…However, the pathogenesis remains difficult to establish and is probably multifactorial also related to neutropenia and potential treatment side effects. Vasospasm might also have favored necrosis and infection, similarly to the nasal septum perforation that can occur in patients with psoriasis and Raynaud phenomenon (4). The diagnosis of aspergillus sinusitis is important, as the accumulated mucus may result in nasal obstruction, and progress to facial deformity with osteolytic destruction, and intracranial extension and, the surgical procedure may be complicated by intracerebral hemorrhage (5,6).…”

Nasal septal ulceration

“…The biopsy did not help in further management of patients and in vasculitis, tests like cytoplasmic antineutrophil cytoplasmic antibody test and clinical features of vasculitis helped better in diagnosing the disorders. In most cases of rheumatic diseases or vasculitis, biopsy shows only chronic inflammation, 48 but as a biopsy has a high predictive value when it is positive in vasculitis, it should be done in all suspect cases. 49 The therapy depends on the cause and a brief overview is given below ( Table 2).…”