1. GRANULOMATOUS DISORDERS OF NOSE

2. Bacterial Tuberculosis Tuberculosis Leprosy Leprosy Histiocytosis Histiocytosis Anthrax Anthrax Glanders Glanders Gangosa Gangosa Lupus vulgaris Lupus vulgaris Syphilis Syphilis

3. Tuberculosis Usually secondary with a rapid course Usually secondary with a rapid course Nodular,ulcerative or polyp Nodular,ulcerative or polyp Little pain Little pain Mucosa bright red looking Mucosa bright red looking Afb,bacteriology or biopsy confirms Afb,bacteriology or biopsy confirms Antituberculous treatment Antituberculous treatment Saline douches Saline douches

4. Leprosy Tuberculoid solitary anaesthetic skin patches solitary anaesthetic skin patches nerve palsies nerve palsiesBorderline poor resistance,low immunity,multiple skin lesions poor resistance,low immunity,multiple skin lesionsLepromatous large No of lepra cells,diffuse infilteration large No of lepra cells,diffuse infilteration

5. Leprosy Loss of smell Loss of smell Atrophic rhinitis Atrophic rhinitis Septal perforation Septal perforation Mucosal nodular thickening Mucosal nodular thickening Microscopy of nasal discharge Microscopy of nasal discharge Miccroscopy of nasal scraping Miccroscopy of nasal scraping X ray pns and nasal X ray pns and nasal Dapsone,cofazimine,rifampicine, local Dapsone,cofazimine,rifampicine, local

6. Lupus vulgaris Indolent,localized and chronic Tb of skin Indolent,localized and chronic Tb of skin Common in females Common in females Affects mucocutaneous junctions Affects mucocutaneous junctions Ulcerative or scarring Ulcerative or scarring Slow course with remission and relapses Slow course with remission and relapses Firm red nodules Firm red nodules Epistaxis,odour,papules, Epistaxis,odour,papules, Fibrosis and distortion Fibrosis and distortion Blanching apple jelly nodules Blanching apple jelly nodules Afb,pcr,montoux Afb,pcr,montoux Att,vit D Att,vit D

7. Syphilis Primary,secondary,tertiary Primary,secondary,tertiary Oedema,infilteration of the stroma with lymphocytes,plasma cells and endothelial cells. Oedema,infilteration of the stroma with lymphocytes,plasma cells and endothelial cells. Perivascular cuffing endarteritis reduce the lumen of the blood vessels and result in necrosis and ulceration Perivascular cuffing endarteritis reduce the lumen of the blood vessels and result in necrosis and ulceration

8. Fungal granulomas Saprophitic,rigid cell walls,grow by buddi Saprophitic,rigid cell walls,grow by buddi Immunocompromised,diabetic,hiv,organ transplant,malnutrition,patients on steroids,chemotherapy,antibiotics etc Immunocompromised,diabetic,hiv,organ transplant,malnutrition,patients on steroids,chemotherapy,antibiotics etc Biopsy,serology Biopsy,serology Amphotericin,ketocanazole,clotrimazole Amphotericin,ketocanazole,clotrimazole

9. Fungal granulomas Rhinosporidiosis Rhinosporidiosis Mucormycosis Mucormycosis Aspergillosis Aspergillosis Actinomycosis Actinomycosis Candidiasis Candidiasis Blastomycosis Blastomycosis Histoplasmosis Histoplasmosis sporotrichosis sporotrichosis

10. Non specified granulomas Wegeners granuloma Wegeners granuloma Stewarts granuloma Stewarts granuloma

11. Wegeners granuloma Systemic autoimmune vasculitis Systemic autoimmune vasculitis Non healing Non healing Anca autoantibodies to the neutrophil cytoplasmic antibodies Anca autoantibodies to the neutrophil cytoplasmic antibodies Necrotizing granuloma of respiratory tract Necrotizing granuloma of respiratory tract Giant and epitheliod cells Giant and epitheliod cells Focal necrosive gn of kidneys Focal necrosive gn of kidneys Progressive painless ulcers Progressive painless ulcers

12. wegeners Nasal bstruction,granulation,saddle nose Nasal bstruction,granulation,saddle nose Nasal ulceration Nasal ulceration Recurrent sinusitis Recurrent sinusitis Epistaxis Epistaxis Productive cough with hemoptysis Productive cough with hemoptysis Cavity formation in cxr Cavity formation in cxr Recurrent uti and haematuria Recurrent uti and haematuria Renal failure Renal failure others others

13. wegeners Positive histology Positive histology Involvement of two out of three regions Involvement of two out of three regions Raised ESR Raised ESR Cast cells in urine Cast cells in urine Renal,nasal biopsy Renal,nasal biopsy Raised c-anca levels Raised c-anca levels Raised p-anca Raised p-anca

14. Wegeners Prednisolone Prednisolone Cyclophosphamide Cyclophosphamide azothioprine azothioprine

15. Stewarts granuloma Non healing midline granuloma Non healing midline granuloma Eb virus Eb virus Atypical cellular exudate and necrosis Atypical cellular exudate and necrosis Resemble t cell lyphoma Resemble t cell lyphoma Creeping slow midfacial destruction Creeping slow midfacial destruction No systemic involvement No systemic involvement Radiotherpy,surgical debridement,chemotherapy Radiotherpy,surgical debridement,chemotherapy