GRANULOMATOUS GRANULOMATOUS DISORDERS OF NOSEDISORDERS OF NOSE

BacterialBacterial

TuberculosisTuberculosis LeprosyLeprosy HistiocytosisHistiocytosis AnthraxAnthrax GlandersGlanders GangosaGangosa Lupus vulgarisLupus vulgaris SyphilisSyphilis

TuberculosisTuberculosis

Usually secondary with a rapid courseUsually secondary with a rapid course Nodular,ulcerative or polypNodular,ulcerative or polyp Little painLittle pain Mucosa bright red lookingMucosa bright red looking Afb,bacteriology or biopsy confirmsAfb,bacteriology or biopsy confirms Antituberculous treatmentAntituberculous treatment Saline douchesSaline douches

LeprosyLeprosy

TuberculoidTuberculoid solitary anaesthetic skin patchessolitary anaesthetic skin patches nerve palsiesnerve palsiesBorderlineBorderline poor resistance,low immunity,multiple poor resistance,low immunity,multiple

skin lesionsskin lesionsLepromatousLepromatous large No of lepra cells,diffuse large No of lepra cells,diffuse

infilterationinfilteration

LeprosyLeprosy

Loss of smellLoss of smell Atrophic rhinitisAtrophic rhinitis Septal perforationSeptal perforation Mucosal nodular thickeningMucosal nodular thickening Microscopy of nasal dischargeMicroscopy of nasal discharge Miccroscopy of nasal scrapingMiccroscopy of nasal scraping X ray pns and nasalX ray pns and nasal Dapsone,cofazimine,rifampicine, localDapsone,cofazimine,rifampicine, local

Lupus vulgarisLupus vulgaris

Indolent,localized and chronic Tb of skinIndolent,localized and chronic Tb of skin Common in femalesCommon in females Affects mucocutaneous junctionsAffects mucocutaneous junctions Ulcerative or scarringUlcerative or scarring Slow course with remission and relapsesSlow course with remission and relapses Firm red nodulesFirm red nodules Epistaxis,odour,papules,Epistaxis,odour,papules, Fibrosis and distortionFibrosis and distortion Blanching apple jelly nodulesBlanching apple jelly nodules Afb,pcr,montouxAfb,pcr,montoux Att,vit DAtt,vit D

SyphilisSyphilis

Primary,secondary,tertiaryPrimary,secondary,tertiary Oedema,infilteration of the stroma Oedema,infilteration of the stroma

with lymphocytes,plasma cells and with lymphocytes,plasma cells and endothelial cells .endothelial cells .

Perivascular cuffing endarteritis Perivascular cuffing endarteritis reduce the lumen of the blood reduce the lumen of the blood vessels and result in necrosis and vessels and result in necrosis and ulcerationulceration

Fungal granulomasFungal granulomas

Saprophitic,rigid cell walls,grow by Saprophitic,rigid cell walls,grow by buddibuddi

Immunocompromised,diabetic,hiv,organ Immunocompromised,diabetic,hiv,organ transplant,malnutrition,patients on transplant,malnutrition,patients on steroids,chemotherapy,antibiotics etcsteroids,chemotherapy,antibiotics etc

Biopsy,serologyBiopsy,serology Amphotericin,ketocanazole,clotrimazoleAmphotericin,ketocanazole,clotrimazole

Fungal granulomasFungal granulomas

RhinosporidiosisRhinosporidiosis MucormycosisMucormycosis AspergillosisAspergillosis ActinomycosisActinomycosis CandidiasisCandidiasis BlastomycosisBlastomycosis HistoplasmosisHistoplasmosis sporotrichosissporotrichosis

Non specified granulomasNon specified granulomas

Wegeners granulomaWegeners granuloma Stewarts granulomaStewarts granuloma

Wegeners granulomaWegeners granuloma

Systemic autoimmune vasculitisSystemic autoimmune vasculitis Non healingNon healing Anca autoantibodies to the neutrophil Anca autoantibodies to the neutrophil

cytoplasmic antibodiescytoplasmic antibodies Necrotizing granuloma of respiratory tractNecrotizing granuloma of respiratory tract Giant and epitheliod cellsGiant and epitheliod cells Focal necrosive gn of kidneysFocal necrosive gn of kidneys Progressive painless ulcersProgressive painless ulcers

wegenerswegeners

Nasal bstruction,granulation,saddle noseNasal bstruction,granulation,saddle nose Nasal ulcerationNasal ulceration Recurrent sinusitisRecurrent sinusitis EpistaxisEpistaxis Productive cough with hemoptysisProductive cough with hemoptysis Cavity formation in cxrCavity formation in cxr Recurrent uti and haematuriaRecurrent uti and haematuria Renal failureRenal failure othersothers

wegenerswegeners

Positive histologyPositive histology Involvement of two out of three regionsInvolvement of two out of three regions Raised ESRRaised ESR Cast cells in urineCast cells in urine Renal,nasal biopsyRenal,nasal biopsy Raised c-anca levelsRaised c-anca levels Raised p-ancaRaised p-anca

WegenersWegeners

PrednisolonePrednisolone CyclophosphamideCyclophosphamide azothioprineazothioprine

Stewarts granulomaStewarts granuloma

Non healing midline granulomaNon healing midline granuloma Eb virusEb virus Atypical cellular exudate and necrosisAtypical cellular exudate and necrosis Resemble t cell lyphomaResemble t cell lyphoma Creeping slow midfacial destructionCreeping slow midfacial destruction No systemic involvementNo systemic involvement Radiotherpy,surgical Radiotherpy,surgical

debridement,chemotherapydebridement,chemotherapy