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A 10-year-old girl was referred for nasal deformity and uncontrolled asthma. The nasal deformity had begun 10 months previously, associated initially with epistaxis and nasal obstruction then with fever and weight loss for 1 month.
At physical examination, the patient appeared emaciated, with a ‘saddle nose’ deformity, rattly breathing and wheezing (figure 1).
Contributors J-BL and LG-C and wrote the case report. MB, NT, SB, CS and AB critically read the manuscript. SB performed ENT endoscopy and evaluation. AB was involved in expert national multidisciplinary discussion. J-BL, LG-C, MB, NT, SB, CS and AB contributed to the clinical management and the diagnosis for this patient and approved the final version of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.