Case Report

Japanese Journal of Rheumatology

, Volume 7, Issue 3, pp 183-188

A case of nasal T cell lymphoma with lethal midline granuloma which is clinically indistinguishable from Wegener’s granulomatosis

  • Toshihiro NankiAffiliated withFirst Department of Internal Medicine, Tokyo Medical and Dental University
  • , Ryuji KoikeAffiliated withFirst Department of Internal Medicine, Tokyo Medical and Dental University
  • , Noboru MizushimaAffiliated withFirst Department of Internal Medicine, Tokyo Medical and Dental University
  • , Hitoshi KohsakaAffiliated withDivision of Immunological Diseases, Medical Research Institute, School of Medicine, Tokyo Medical and Dental University
  • , Tetsuo KubotaAffiliated withFirst Department of Internal Medicine, Tokyo Medical and Dental University
  • , Nobuyuki MiyasakaAffiliated withFirst Department of Internal Medicine, Tokyo Medical and Dental University

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

We describe a patient who developed fever, bilateral otitis media, destructive necrosis of the nasal cavity and multiple lung nodules. The patient fulfilled the American College of Rheumatology (ACR) classification criteria for Wegener’s granulomatosis (WG) and was also diagnosed as having WG by using the ACR classification tree. However, the diagnosis of T cell lymphoma was finally made by cervical lymph node biopsy, 2 years after disease onset. Rheumatologists should therefore aware of the pitfall of using diagnostic criteria and repetitive biopsy is strongly recommended for accurate diagnosis of WG.

Key words

lethal midline granuloma Wegener’s granulomatosis nasal T cell lymphoma Epstein-Barr virus