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Clinical Problem Solving: Pathology
Oct 2012

Pathology Quiz Case 2: Diagnosis

Arch Otolaryngol Head Neck Surg. 2012;138(10):982-983. doi:10.1001/archotol.138.10.982

Diagnosis: Wegener granulomatosis (WG) with superimposed fungal infection

Our patient presented with chronic rhinosinustis that was refractory to treatment and sinonasal destruction, a nonspecific presentation that can pose a diagnostic dilemma. Our differential diagnosis for this midline destructive process included infectious causes such as an invasive fungal sinusitis or syphilis; autoimmune diseases such as WG and other antineutrophil cytoplasmic antibody (ANCA)-positive vasculidities, sarcoidosis, and Behçet syndrome; neoplasia, especially a natural killer–T-cell lymphoma; and traumatic causes such as cocaine abuse.1 The cause of a midline destructive lesion can usually be elucidated by a systematic approach, including laboratory tests, tissue biopsy, and cultures.2

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