Clinical Problem Solving: Pathology |

Pathology Quiz Case 2

James Martin, MD; Kevin C. Welch, MD
Arch Otolaryngol Head Neck Surg. 2012;138(10):981. doi:10.1001/2013.jamaoto.51.
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A 51-year-old woman with more than 1 year of intermittent sinus complaints presented with 4 to 5 months of worsening congestion, facial pressure and pain, foul-smelling discharge, epistaxis, and hyposmia. She also reported a 7-kg weight loss. Her symptoms progressed despite repeated courses of amoxicillin-clavulanate, levofloxacin, prednisone, and gentamicin irrigations. She was subsequently referred to us for further evaluation and management. On physical examination, she was afebrile and tender over her maxillary sinuses, especially on the right side. She had a perforated septum, purulent rhinorrhea, and substantial erosion of the turbinates on the right. Nasal endoscopy revealed significantly altered anatomy marked by destruction of the right posterior ethmoids and the posterosuperior septum. Purulence coated the entire sinonasal contents with widespread crusting and areas suggestive of necrosis.

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