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Clinical Challenge
June 17, 2021

Nasal Mass in a Middle-aged Woman With Multiple Myeloma and Recurrent Fungal Sinusitis

Author Affiliations
  • 1Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles
JAMA Otolaryngol Head Neck Surg. 2021;147(8):764-765. doi:10.1001/jamaoto.2021.1142

A woman in her 50s was admitted to the hospital with new left-sided nasal congestion, facial pain, and cheek numbness. Her medical history included kappa light chain multiple myeloma refractory to multiple chemotherapeutic regimens. She had been admitted 4 months earlier with similar symptoms of facial pain and sinus pressure. At that time, she was found to have persistent sinus mucormycosis, which required multiple rounds of surgical debridement. On this admission, her vital signs were stable, and she was afebrile. Laboratory test results showed a white blood cell count of 0.97 × 109 per liter with absolute neutrophil count of 650 × 106 per liter and platelet level of 17 × 109 per liter. A computed tomography scan showed complete opacification of the left paranasal sinuses (Figure, A). The patient underwent surgical debridement, and a prominent erythematous soft-tissue mass was seen in her left nasal vestibule (Figure, B). The nasal mass was resected for pathologic analysis (Figure, C).

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