Page 86 - FINAL COMPENDIUM 2020-2021 27.2.2022

MIDLINE LETHAL GRANULOMA: A RARE CASE REPORT

Mohan K, Rengarajoo J, Leong JZ, Ropi M, Royan SJ, Kohir S

Introduction: This case report highlights a case of midline lethal granuloma, a rare disease
with a high mortality rate due to its difficulty in diagnosing the disease. The aetiology of
sudden onset of palatal ulceration which leads to perforation of the palate can be
attributed to inflammatory, infection, immune-mediated response, iatrogenic and
neoplastic causes. Case report: We report a case of a 20-year-old male, presented with
non-healing palatal ulcers of 2 weeks’ duration and progressive onset of nasal obstruction,
weakness, loss of appetite, loss of weight with intermittent episodes of fever. In-situ
hybridization for the Epstein-Barr encoding region was positive. Biopsy results were
reported as extranodal natural killer/T-cell lymphoma, nasal type which has a specific
predilection for the facial midline structure. The patient was treated with non-
anthracycline-based chemotherapy regime (etoposide, oxliptin, gemcitabine) with
adjunct antibiotics. However, he succumbed to the disease during treatment. Conclusion:
This case is reported to encourage fellow clinician to have a high index of suspicion when
they encounter chronic midline palatal necrotic ulceration, in which extranodal NK/T cell
lymphoma should not be ruled out.

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Oral Presentation at the 25 Annual MAOMS Scientific Conference on 19-20 March 2021 (virtual conference)
Abstracts of free papers presented at the 25 MAOMS Annual Scientific Meeting on Friday, 19 March 2021. (2021).
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Malaysian Journal of Oral Maxillofacial Surgery, 19(1), 30–59. Retrieved from
https://mjoms.my/index.php/mjoms/article/view/156
Dr Kesavan Mohan
Dr Muhammad Ropi bin Mamat
Dr Stephen Joseph Royan
Dr Sutina bt Kohir
Department of Oral and Maxillofacial Surgery
Hospital Tuanku Ja’afar
Seremban, Negeri Sembilan
Malaysia

Dr Jonathan Rengarajoo
Department of Oral and Maxillofacial Surgery
Hospital Kuala Lumpur
Wilayah Persekutuan Kuala Lumpur
Malaysia

Dr Leong Jia Zheng
Klinik Pergigian Petaling
Hospital Jelebu, Kuala Klawang
Jelebu, Negeri Sembilan
Malaysia

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