Aspergillosis of the Nasal Cavity Secondary to Nasal Septal Perforation; A Case Report.

We treated a patient with aspergillosis of the nasal cavity which was secondary to a nasal septal perforation. This 67-year-old man was diagnosed with acute myelogenous leukemia (AML)(M2) and received chemotherapy (JALSG AML 92). During the course of the chemotherapy, he complained of nasal obstruction and an abnormal sensation in his mouth. His nasal cavity was filled with dark brown crusts, which were very hard and adherent. X-ray films of the paranasal sinus revealed a deviation of the nasal septum to the left, and the shape of nasal septum opaquely. A CT scan of the paranasal sinus showed the septal deviation and a partial deficit in the mucous membrane of nasal septum. A blood test showed a bleeding tendency because of bone marrow suppression. Therefore, we avoided removing the crusts forcibly, and used fibrinolysin ointment on the crusts in the nasal cavity daily. The amount of crust formation decreased daily. Two weeks after this treatment, all of the crusts were easily removed as a mass.A perforation of the nasal septum was discovered. There were no inflammatory changes noted in the mucous membranes of the nasal cavity or inferior turbinates. The removed specimen measured 30×20×15mm. Histologically, the central part of the lesion consisted of necrotizing cartilage and bone tissue, which was covered with connective tissue and necrotic tissue, including the fungal mass.PAS and Grocott stains of the specimen partially revealed the hyphae with 45-degree branching. The pathological diagnosis was aspergillosis. We observed this patient throughout this treatment, and the crusts in the nasal cavity disappeared and his nasal obstruction improved. However, he developed pneumonia and died of septicemia.