Differential Diagnosis for Internal Nasal Ulcer
- Single most likely diagnosis
- Nasal septal perforation or ulcer due to nasal septum trauma or dryness: This is a common cause of internal nasal ulcers, often resulting from trauma, nasal picking, or extreme dryness of the nasal mucosa.
- Other Likely diagnoses
- Infectious causes (bacterial, viral, or fungal): Infections such as syphilis, tuberculosis, or fungal infections like mucormycosis can cause nasal ulcers.
- Allergic or inflammatory conditions: Conditions like allergic rhinitis, granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), or sarcoidosis can lead to nasal ulcers.
- Nasal drug abuse: Cocaine or other drug abuse can cause nasal ulcers due to the toxic effects of the drugs on the nasal mucosa.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignancy (e.g., squamous cell carcinoma, basal cell carcinoma, or other nasal cavity tumors): Although less common, malignancies can present as nasal ulcers and are critical to diagnose early.
- Syphilis: Especially in its tertiary stage, syphilis can cause destructive lesions in the nose, known as gummas, which can mimic ulcers.
- Granulomatosis with polyangiitis (GPA): This condition can cause destructive lesions of the nasal passages and sinuses and is important to diagnose due to its potential for serious complications.
- Rare diagnoses
- Relapsing polychondritis: A rare autoimmune disorder that can cause inflammation and destruction of cartilaginous structures, including those in the nose.
- Midline destructive granuloma: A rare condition that can cause destruction of the midline facial structures, including the nose, due to various causes including infection, inflammation, or malignancy.
- Leishmaniasis: In rare cases, especially in endemic areas, leishmaniasis can cause nasal ulcers as part of its clinical presentation.