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A 48-year-old man presented with a 2-year history of nasal obstruction, which was worse on the left side and caused secondary mouth breathing. Previous extensive investigation at a major specialist unit had revealed no abnormalities and had resulted in no clear diagnosis. On physical examination, there was significant inflammation and swelling of the nasal mucosa, with superficial yellow crusting and contact bleeding. The results of subsequent skin prick tests, radioallergosorbent tests, an autoantibody screen, and an antineutrophil cytoplasmic antibody test were negative, and all immunoglobulin levels were normal. The serum angiotensin-converting enzyme level was slightly elevated (63 U/L [to convert to nanokatals per liter, multiply by 16.667]). A chest x-ray film was unremarkable. A computed tomogram demonstrated marked loss of the nasal airway secondary to diffuse thickening of the nasal septum and mucosa of the nasal floor.
Syed I, Smithard A, Sharif H, Bleach N. Pathology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2009;135(7):720-723. doi:10.1001/archoto.2009.63-a