Necrotic lesions in the nasal cavity are induced by a variety of diseases that cause necrosis of the mucosa, bone, and cartilage in the nasal cavity, and Wegener's granulomatosis and sinonasal natural killer cell or T-cell lymphoma must be included in the differential diagnosis. Necrotic lesions induced by cocaine inhalation, on the other hand, are very rare in Japan, and cocaine inhalation also needs to be included in the differential diagnosis.
We report the case of a 33-year-old male who complained of nasal pain and necrosis in the nasal cavity. Although we initially suspected Wegener's granulomatosis based on the endoscopic findings and results of laboratory tests, especially based on a slight elevation of the PR3-ANCA value, we did not detect any giant cell granulomas or necrotizing vasculitis, which are histological characteristics of Wegener's granulomatosis in repeatedly biopsyed specimens. Systemic steroid therapy was started based on suspicion of localized Wegener's granulomatosis, but was ineffective. Two months after the start of treatment, the patient failed to return for follow up. He was later arrested for the illegal possession of cocaine, and we realized that the necrotic lesions were caused by cocaine inhalation.
Necrosis induced by cocaine inhalation should be included the differential diagnosis of necrotic nasal lesions.