[Granuloma gangraenescens of the nose]

An extremely rare observation of gangrenizing granuloma of the nose in a woman of 29 with a fatal outcome is presented. The disease is characterized by rapidly developing changes in the nasal mucosa and sinuses, skin, soft tissues of the face, destruction of cartilage and bone tissues of the nose, upper jaw with perforation of the hard palate and loss of teeth. Wegener's granulomatosis was diagnosed in the hospital. The disease was complicated by multiple errosive bleedings and sepsis. The lack of involvement of the internal organs and granulomatous reaction distinguished the present observation from the classic Wegener's granulomatosis. The presence of marked vascular changes with fibrinoid necrosis of vessel walls and thrombosis, large necrotic areas and accumulation of plasma cells should be regarded as manifestations of hyperergic reaction of the immediate type. The abundance of microbes and polymorphonuclear leukocytes indicates the occurrence of a secondary infection and purulent inflammation.