Author(s)
Jee-hong Kim, MD
Yuna Kim, Resident
Alison Yu, Resident
Affiliation(s)
University of Nevada Las Vegas;
Abstract:
Intro: Extranodal natural killer/T-cell (NK/T-cell) lymphoma, nasal type, is a rare and aggressive form of lymphoma resulting in progressive midline facial destruction. This case report documents a distinctive presentation and diagnostic challenge in an otherwise healthy patient.
Case: 19-year-old Hispanic male initially presented with painless right facial swelling. He was treated with a two-week course of antibiotics. However, the patient returned with worsening periorbital edema, and a CT scan revealed complete opacification of the right maxillary sinus. The patient underwent functional endoscopic sinus surgery (FESS) and received intravenous antibiotics. Despite these interventions, his clinical condition deteriorated, with the extension of tissue edema to the right hemi-face and the development of ophthalmoplegia.
Subsequent MRI findings indicated the progression of the disease to involve the right masticator space, pterygopalatine fossa, infratemporal fossa, and temporal space. An endoscopic secondary examination revealed extensive tissue necrosis in this region, sparing septum and palate, which raised concerns regarding necrotizing fasciitis or invasive fungal disease. However, after an Epstein-Barr virus stain and additional staining, a definitive diagnosis of NK/T-cell lymphoma was established.
Significance: This case underscores the significance of considering uncommon pathologies in patients exhibiting aggressive symptoms akin to sinusitis that do not respond to standard treatments. NK/T-cell lymphoma should be considered as a potential diagnosis, even in the absence of midline nasal destruction. While extensive tissue necrosis is a hallmark of the disease, it is advisable to avoid radical surgical intervention