A 67-year-old lady presented to the Otorhinolaryngology clinic with complaints of right nasal obstruction for the past 6 months. She had no symptoms of persistent rhinorrhoea, recurrent epistaxis, anosmia, facial pain, facial numbness, headache, epiphora and diplopia. She had neither accompanying ear or throat symptoms nor preceding history of trauma or infection. She was a non-smoker, with no known occupational exposure risk factors. Endoscopic examination revealed a firm, smooth surface lobulated red mass arising from the right anterosuperior septum impinging on the inferior turbinate. The left nasal cavity looked normal. The nasopharynx, oropharynx and larynx were otherwise normal. There were no palpable cervical lymph nodes. Our initial working diagnosis was pyogenic granuloma, septal turbinate or nasal lymphoma. We proceeded with an office biopsy of the mass to rule out malignancy.Biopsy of the mass resulted in minimal bleeding and haemostasis was secured. Proliferation of thin-walled vessels in dense fibrous stroma was seen in the biopsy specimen, and histologically the mass was diagnosed as an angiofibroma [Table/ Fig-1]. A computerized tomography (CT) scan with contrast revealed a localised welldefined small mildly enhancing soft tissue lesion measuring 0.8cm by 0.4cm by 0.8cm, confined to the right anterosuperior septum with mild deviation of the nasal septum to the right. The soft tissue ABSTRACTJuvenile angiofibromas (JAs) are well-characterised in literature, arising typically in the posterolateral wall of the nasal cavity of young males. Numerous theories have been proposed to explain the occurrence of this unique and rare tumour. Angiofibromas originating in other sites within the head and neck have been described but this is exceedingly rare, constituting less than 2% of all diagnosed cases. Extranasopharyngeal angiofibroma is a rare lesion, and more importantly, controversial. It is not known whether it is actually a relative of the well-known JA that is seen exclusively in adolescent males. We present the case of a post-menopausal woman with unilateral nasal obstruction who was unexpectedly diagnosed as nasal septal angiofibroma.

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Acute invasive fungal rhinosinusitis is a rare sinonasal infection. It usually occurs in immunocompromised patients. The presentation of acute invasive fungal rhinosinusitis with disseminated fusariosis mimicking varicella zoster cutaneous lesion is extremely rare in otorhinolaryngology practice. The morbidity and mortality rates in immunocompromised patient are high and determined by proper management of the disease. Therefore, appropriate investigation and management are very important. We describe a case of acute invasive fungal rhinosinusitis with disseminated fusariosis in a child presenting with cutaneous lesions mimicking varicella zoster associated with nasal pain and eschar. This report also emphasised the important role of an otorhinolaryngologist in the early diagnosis and management of acute invasive fungal rhinosinusitis.