A Woman with Persistent Nasal Ulceration

Nasal endoscopy showed marked, multifocal crusting and ulceration. She had immigrated from Honduras 15 years ago and reported a nonhealing skin lesion as a child. Common causes of nasal crusting (e.g., digital trauma, surgery, intranasal sprays, drug use) were eliminated by history. Rarer diseases (e.g., vasculitis, IgG4-related disease) entered the picture, prompting nasal biopsy. Histopathological examination showed granulomas (Figure 1), and a nucleic acid amplification test identified Leishmania braziliensis.