Intended for healthcare professionals

Endgames Case Review

Painful nasal and oral lesions

BMJ 2020; 371 doi: (Published 25 November 2020) Cite this as: BMJ 2020;371:m3778
  1. Pin-Hsuan Chiang, fellow,
  2. Chi-Hui Wang, consultant,
  3. Chun-Bing Chen, consultant
  1. Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  1. Correspondence to: C-B Chen chunbing.chen{at}

A man in his 60s presented with painful erythematous plaques and vesicles on the right side of his nose and palate that had appeared three days earlier. Before he noticed the skin lesions, he had a stinging and itchy sensation for two days on the external aspect of his nose. Cutaneous examination showed scattered erythematous plaques and crusted blisters on the right side of his nose, midface (fig 1a), upper eyelid, and forehead (fig 1b), extending to the anterior scalp. Intraoral inspection showed multiple ulcerations overlying whitish slough on the right side of the hard palate, gingiva, and oral mucosa (fig 1c).

Fig 1

Cutaneous and mucosal lesions

Nasopharyngoscopy to evaluate the intranasal lesions showed a pre-existing perforation of the nasal septum. Lesions were present …

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