Febrile nasal obstruction: What is your diagnosis?

Extranodal nasal-type NK/T-cell lymphoma is a rare and aggressive malignancy, usually reported in East Asian populations. Its initial presentation may mimic chronic infection or necrotizing vasculitis, leading to diagnostic delay and therapeutic errors.
We report the case of a 63-year-old man with no significant medical history who presented with febrile bilateral nasal obstruction evolving for one month, associated with palatal ulceration and facial edema. Computed tomography revealed extensive inflammatory sinus involvement without bone destruction. The first biopsy suggested Wegener’s granulomatosis, but antineutrophil cytoplasmic antibodies (ANCA) were negative. Immunohistochemistry subsequently confirmed an extranodal NK/T-cell lymphoma of nasal type.
Necrotizing sinonasal lesions resistant to antibiotic therapy should raise suspicion of NK/T-cell lymphoma, even in non-endemic regions. Early histopathological and immunohistochemical confirmation is crucial for appropriate management and improved prognosis