case_images: PMC6936917_01
case_images: Appearance of the patient at admission. Hard palate perforation (A) and a skin ulcer on the right hand (B) were observed. Nasal endoscopy demonstrated a bloody and purulent discharge with severe inflammation (C)
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case_images: PMC6936917_01_1299_Fig1.jpg
case_images: f1-1299-1-10088-1-10-20191119
case_images: After admission to our facility, his examination revealed a temperature of 37.8 C, blood pressure of 124/76 mmHg, a pulse rate of 83 beats/minute, and purulent skin ulcers in the right hand and left knee (Fig. 1B).
case_images: Histological findings in the nasal cavity and iliac bone. The vasculitic lesions were observed in a small artery of the nasal cavity, characterised by fibrinoid necrosis and eosinophilic infiltrates (A). Extravascular granulomas were observed in the nasal cavity, which were composed of giant cells and palisading immune cells (B). Eosinophilic infiltration of iliac bone was observed (C)
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case_images: f3-1299-1-10088-1-10-20191119
case_images: Granulomatous inflammation with multinucleated giant cells and vasculitis were seen in the nasal cavity bone (Fig. 3A,B). Severe inflammation with multiple eosinophils was seen in the left iliac bone (Fig. 3C).
case_images: Significantly decreased FDG uptake on PET/CT was seen 3 months after intensive treatment
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case_images: PMC6936917_01_1299_Fig4.jpg
case_images: f4-1299-1-10088-1-10-20191119
case_images: Three months after treatment with cyclophosphamide, a steroid and anti-NTM medication (clarithromycin, ethambutol and rifampin), the abscesses in the right hand and left knee resolved with improvement noted on follow-up PET/CT (Fig. 4).