There are only possible diagnoses for Sherlock Holmes: When illnesses are rare


There are three considerations to make in this clinical case, the first one the importance of listening to the patient, the second one to invest time “looking” at the area where the problem is referred by the patient, above all when there is an easy access, and the last one, the knowledge of specific details or markers that can help to select a diagnosis.


Clinical Case

A 72-year-old man with a previous diagnosis of localized prostate cancer. He started one year and a half ago with a feeling of nasal obstruction without bleeding or mucus. This symptom was always present during this period of time, but in the last month he started with some bleeding and mucus and more difficulty in breathing. He went to the otorhynolaringologist  who saw a granulomatous lesion in the left of the nasal septum, taking a sample for a biopsy.

You can see here an image of the patient and a complementary information to reach the diagnosis:


What is your diagnosis?

  1. EBV-positive diffuse large B cell lymphoma, NOS
  2. Lymphomatoid granulomatosis
  3. Nasal-type NK/T cell lymphoma

To Know the correct answer click here

Author: Dr. Lorenzo Alonso Carrión