An unclear, chronic nasal ulcer

A 44-year-old Brazilian man presented with an eight-month history of runny nose, hoarseness and progressive gingival swelling, which interfered greatly with nourishment and oral hygiene. The nasal lesion had appeared three years previous to his visit, while the gingival lesions had been present for a few months. The patient had been already seen by general practitioners and dentists and had received nonspecific therapy. He was not taking any drugs. Physical examination showed a painless ulceration on the right nasal fossa (Figure 1) and hyperplastic erythematous lesions on the upper gingival mucosa (Figure 2). He had no fever and there was no lymphadenopathy nor hepatosplenomegaly. Full blood count, liver and kidney function tests were within the normal range. HIV-serology was negative. Cultures for bacteria, fungus and mycobacteria were negative. Histological examination of a gingival lesion revealed a granulomatous inflammation without necrosis. Fite, Grocott methanamine silver and Periodic Acid Schiff stains were negative. What is your diagnosis? Figure 1. Painless ulceration on the right nasal fossa.