Rare occupational cause of nasal septum perforation: Nickel exposure

Abstract

Many etiologies are held accountable for nasal septum perforations. Topical nasal drug usage, previous surgeries, trauma, nose picking, squamous cell carcinoma, some rheumatological disorders such as granulomatosis with polyangiitis (Wegener granulomatosis), some infectious diseases such as syphilis and leprosy are among the causes of the perforations. Occupational heavy metal exposures by inhalation rarely may also cause nasal septum perforation. Here, we present a 29-year-old patient without any known diseases, who is a worker at a metallic coating and nickel-plating factory, referred for investigation of his nasal cartilage septum perforation from an otorhinolaryngology clinic. The patient questioning, physical examination and laboratory assessment about rheumatic and infectious diseases were negative. There was a metallic smell in the breath during the physical examination. The analysis showed serum nickel level at 31 μg/l and urine nickel at 18 μg/l (84.11 μg/g creatinine). Other possible serum and urine heavy metal levels were within normal ranges. Nickel exposure is usually together with other heavy metals (chromium or cadmium), it is rarely alone. Nickel ingested by inhalation usually leads to respiratory problems such as reduced olfactory acuity, ulcers, septum perforation or tumors of the nasal sinuses. This case demonstrates the importance of occupational anamnesis and awareness of diagnosis. Int J Occup Med Environ Health 2017;30(6):963 -967

Nasal Septum Perforation Associated to Histoplasmosis: A Retrospective Study

“…It may mimic other pathologies including trauma, autoimmune or immunosuppressing disorders (SEL, Rheumatoid Arthritis, etc. ), infections (Syphilis, leishmaniasis, tuberculosis, leprosy and other fungal infections), neoplasia and other causes such as steroid or vasoconstrictor nasal spray usage, chronic cocaine abuse and chrome industry mining [13][14][15][16][17][18]. Why NSP occurs in histoplasmosis is unknown.…”

Identification of core carcinogenic elements based on the age-standardized mortality rate of lung cancer in Xuanwei Formation coal in China

“…Exposure to nickel in the environment is related to human lung cancer and nasal cancer 104 , 129 , and research has shown that its triggering of DNA damage (cell cycle imbalance) is an important carcinogenic mechanism. In vitro and in vivo experiments show that nickel can produce reactive oxygen species by binding DNA, mediating DNA damage and inhibiting DNA repair 130 , 131 .…”

Septal perforations – state of the art

“…Nasal septal perforation can appear secondary to Nickel exposure. It was observed that Nickel plating and refinery workers have a higher risk of sinusitis, rhinitis, nasal septal perforation, fibrosis, asthma and emphysema secondary to long term exposure to contaminated air 21 .…”