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Rare disease
CASE REPORT
Extranodal NK/T cell lymphoma, nasal type, with retrobulbar extraconal phlegmon and naso-oral fistula
  1. Daniel Jun Yi Wong1,
  2. Louise Ann Parry2,
  3. Aaron Elijah Bloch2 and
  4. Nicholas Agar1
  1. 1 Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
  2. 2 Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
  1. Correspondence to Dr Daniel Jun Yi Wong, daniel.jy.wong{at}gmail.com

Abstract

Extranodal natural killer (NK-)/T cell lymphoma, nasal type (ENKL),1 is a rare disease that often mimics rheumatological and infectious conditions and can therefore be difficult to diagnose. The authors present a case of a 55-year-old Vietnamese woman who was misdiagnosed with severe atrophic rhinitis and chronic sinus osteitis. Over a period of 8 months from initial referral, she underwent multiple biopsies and was treated with various antimicrobial regimens until the histopathological diagnosis of ENKL was finally made. Her presentation was complicated by bacterial dacrocystitis, preseptal cellulitis and a retrobulbar extraconal phlegmon requiring surgical drainage. She also subsequently developed a naso-oral fistula on treatment. This case highlights the importance of repeated biopsies, in particular from non-necrotic regions of the sinonasal tract when a patient does not respond to therapy and clinical suspicion of neoplastic pathology remains. This is the first case of ENKL to describe significant orbital complication.

  • ear, nose and throat/otolaryngology
  • oncology
  • malignant disease and immunosuppression

https://doi.org/10.1136/bcr-2018-227160

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    Footnotes

    • Contributors DJYW, LAP, AEB and NA were involved in the write-up and editing of the case. DJYW was responsible for clarifying history and write up, formatting images, acquisition of data, and editing, conception and also helped in literature review. LAP and AEB were responsible for collating the antibiotic data and organisms cultured from investigations and also edited the manuscript. LAP acquired consent. AEB acquired publications and conducted literature review and contributed to discussion. NA clarified and edited the case history and was involved in the original work-up of the case and took biopsies and also oversaw the case report write-up.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.