A Case of Nasal Septal Necrosis Caused by Aspergillus Infection

Abstract

Necrosis of the nasal cavity can be caused by a wide variety of factors, including nasal natural killer/T-cell lymphoma, granulomatosis with polyangiitis, leukemia, infection, and drugs. We herein report a case of nasal septal necrosis caused by Aspergillus infection. A 78-year-old woman with myelodysplastic syndrome was treated at the Department of Hematology at our hospital. She had a fever, and bone marrow examination showed transition from myelodysplastic syndrome to hypoplastic myelogenous leukemia; thus, chemotherapy was started. At initial presentation, crusts were present on the left side of the nasal septum. A CT scan showed a mass lesion without calcification or bone destruction in the bilateral maxillary sinuses, and MRI T2-weighted images showed low signal intensity in the left maxillary sinus, suggesting the presence of fungi. Decreased platelets were observed and conservative treatment was performed based on the risk of bleeding associated with removal of the crusts. However, crusts started to appear on both sides of the nasal septum, and biopsy revealed Aspergillus in the necrotic tissue. There was no invasion of tumor cells or fungi in the peri-necrotic mucosa. Necrosis of the nasal septum due to Aspergillus infection was suspected, but infiltration of leukemic cells could not be ruled out. Therefore, surgery was performed under general anesthesia for collection of sufficient tissue for biopsy, necrotic tissue removal, and diagnostic treatment of the left maxillary sinus lesion. No tumor cells were detected in the necrotic tissue of the nasal septum, but Aspergillus infiltration was observed, indicating that the necrosis was caused by Aspergillus infection. A caseous matter was present in the maxillary sinus, but pathological examination revealed no fungi.