Nasal septal perforation associated with pyoderma gangrenosum

Area of Science:

• Dermatology
• Otolaryngology
• Pathology

Background:

• Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by painful necrotic ulcers.
• Typically affects the legs and is associated with inflammatory bowel disease or rheumatoid arthritis.
• Head and neck involvement, particularly nasal septal perforation, is exceptionally rare.

Purpose of the Study:

• To report a rare case of pyoderma gangrenosum causing nasal septal perforation.
• To highlight the importance of considering rare systemic etiologies for septal perforation.

Main Methods:

• A case report detailing a 71-year-old male with truncal lesions.
• Histological examination of nasal mucosal biopsies.
• Comprehensive serologic, nonserologic, and clinical evaluations to exclude other diagnoses.

Main Results:

• Histology revealed chronic inflammation and reactive changes, ruling out malignancy.
• Other potential causes of septal perforation, including Wegener's granulomatosis, lymphoma, and vasculitis, were excluded.
• The nasal septal perforation was attributed to pyoderma gangrenosum.

Conclusions:

• Nasal septal perforation can be a manifestation of pyoderma gangrenosum.
• A thorough medical history and physical examination are crucial for identifying systemic causes of septal perforation.
• Rare conditions like PG should be considered in the differential diagnosis of septal perforation.