1. CASE 4 39 yr-old man HIV + 1999 Asymptomatic CD4 810 HIV viral load <40 ABC/3TC/Nevirapine Subzygomatic Bioalcamid facial implants

2. CASE 4 Right sided nasal/sinus fullness/pressure over 6 months…just doesn’t feel right No improvement with nasal steroid spray/trial of antibiotics

3. CASE 4 CT scan unremarkable for nasal/sinus lesions or signs of subclinical infection/inflammation of rt subzygomatic Bioalcamid

4. CASE 4 1 month later with no improvement of non specific rt nasal/sinus fullness/pressure seen by ENT physician Scoped and a small area of nasal septal soft tissue noted to look different than surrounding area

5. CASE 4 Biopsy of this abnormal area revealed plasma cell infiltration…found to be monotypic and compatible with a solitary extraosseus plasmacytoma Serum/urine immunoelectrophoresis, skeletal survey and bone marrow biopsy negative for myeloma

6. CASE 4 Treated with multiple courses of radiotherapy Now symptom free Followed for recurrence of plasmacytoma/development of myeloma