Presence of Phlebitis in Aseptic Nasal Septal Abscess Complicated with Ulcerative Colitis; Possible Association with Granulomatosis with Polyangiitis: A Case Report

Presence of Phlebitis in Aseptic Nasal Septal Abscess Complicated with Ulcerative Colitis; Possible Association with Granulomatosis with Polyangiitis: A Case Report

Tomohiko Ishikawa,^1,2 Jun Suzuki,² Tsuyoshi Shirai,³ Shotaro Koizumi,^1,2 Yoshinori Tsuchiya,⁴ Kasumi Hishinuma,⁵ Yasuhiro Nakamura⁶ and Yukio Katori²

¹Department of Otorhinolaryngology, Japan Community Health Care Organization (JCHO) Sendai Hospital, Sendai, Miyagi, Japan
²Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
³Department of Rheumatology, Tohoku University Hospital, Sendai, Miyagi, Japan
⁴Department of Nephrology, Japan Community Health Care Organization (JCHO) Sendai Hospital, Sendai, Miyagi, Japan
⁵Department of Gastroenterology, Japan Community Health Care Organization (JCHO) Sendai Hospital, Sendai, Miyagi, Japan
⁶Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan

Although nasal septal abscesses are uncommon, their cosmetic complications can be severe. Hence, prompt diagnosis and treatment are important. Here, we report a case of aseptic nasal septal abscess in a patient with proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA)-positive ulcerative colitis (UC), in which phlebitis was observed and granulomatosis with polyangiitis (GPA) might co-exist. A 27-year-old female suffered from intermittent abdominal pain and diarrhea for several years. She visited our hospital complaining of worsening swelling and pain in the middle forehead and fever lasting 2 weeks. Physical examination and computed tomography revealed severe swelling of the nasal septum. The patient was diagnosed with nasal septal abscess, and incision drainage and biopsy from the bilateral nasal septum were performed, which showed severe ulcerative neutrophilic mucositis with phlebitis. Simultaneously, blood examination yielded slight positivity for PR3-ANCA. Colonoscopy, including biopsy, revealed severe inflammation without vasculitis nor granuloma, which led to the diagnosis with PR3-ANCA-positive UC. Phlebitis in the nasal mucosa and elevated PR3-ANCA suggested co-existing GPA; hence, she was treated with glucocorticoids and rituximab. Following treatment, the nasal septal abscess and digestive symptoms disappeared. She was discharged on day 25 without symptom recurrence or major nasal deformity. For the prevention of nasal deformity due to persistent inflammation, prompt administration of immunosuppressive therapy should be considered with adequate evaluations for systemic diseases, including UC and GPA.

Keywords —— antineutrophil cytoplasmic antibody; granulomatosis with polyangiitis; nasal septal abscess; ulcerative colitis; vasculitis

===============================

Tohoku J. Exp. Med 2022, 258, 29-34.

Correspondence: Tomohiko Ishikawa, M.D., Ph.D., Department of Otorhinolaryngology, Japan Community Health Care Organization (JCHO) Sendai Hospital, 2-1-1 Murasakiyama, Izumi-ku, Sendai, Miyagi 981-3281, Japan.

e-mail: tomish1988@gmail.com