Perforations of nasal septum are fairly frequent with an incidence of about 0.9 % and may lead to morbidity than mortality. Common causes are trauma (iatrogenic occasionally nose picking), malignancy, inflammations and infections such as tuberculosis, syphilis, Wegener's granulomatosis, sarcoidosis and fungal infections. Paranasal fungal sinusitis is frequently encountered in clinical practice in both immunocompromised and immunocompetent individuals. Nasal septal perforations caused by species of Aspergillus and Fusarium have been documented. We report a case of nasal septal perforation in a 35-years-old immunocompetent male patient due to Purpureocillium lilacinum, a soil and environmental fungus and an emerging pathogen, which is known to cause various infections in humans with normal and deficient immune system. Fungal aetiology was diagnosed by histopathology and direct smear examination and confirmed by culture. Patient was treated with voriconozole, following Antifungal susceptibility testing (AFST), to which the patient is responding.

PRESENTATION OF CASE 60-year-old male patient, farmer by occupation, with no comorbidities presented with recurrent abdominal swelling of 4 years duration with history of pain in the swelling since previous 2-3 months. He was earlier operated for a swelling at the same site 7 years before in a hospital in a neighbouring small town. Neither the details of that procedure were available, nor it was known the specimen was sent for histopathological examination or not. He was apparently alright for 4 years when he started noticing a small swelling which was gradually increasing in size. Patient started having pain in the swelling since previous 2-3 months which was aggravated on bending and on exertion. There were no other constitutional symptoms like anorexia, weight loss or jaundice. On examination patient was thin built, lean, but otherwise general condition was good. There was no jaundice or anaemia. After local examination of the abdomen revealed a vertical paramedian operative scar in right lower quadrant of abdomen with a prominent 6*5 cm lump underneath the lower third of scar.