Abstract

We report a case of malignant midfacial granuloma or idiopathic midfacial granulomatosis
in a 50-year-old male farmer with no previous history. He was admitted to the department
in an emergency context. The history was reportedly 18 months old. He presented a
symptomatology made of nasal obstruction, fever, headache and rhinorrhea with an altered
general state. He consulted several health facilities. The evolution was marked by the
aggravation of the symptomatology. The examination at admission noted an alteration
of the general state. Examination of the ENT sphere revealed ulcerative-necrotic lesions
with a destructive nasal origin, with bone sequestration, midface edema, and extension to
the sinuses and hard palate. The CT scan revealed bony and cartilaginous lysis, irregular
thickening of the nasal pyramid, continuity of the nasal septum, and isodensity of the
maxillary, ethmoidal, and left sphenoidal sinus walls without total filling. Deep biopsies
were performed under general anesthesia. Histology was consistent with a granulomatous
reaction with progressive tissue destruction. Mycobacterium tuberculosis was absent.
Medical treatment was initiated. The evolution was marked by the extension of the lesions,
malnutrition and the appearance of generalized oedema. The patient died on the 45th day of
his hospitalization in a septic shock situation

Keywords

granulomatosis, mediofacial, management, literature review