A 46-year-old woman presented with nasal congestion, mucopurulent rhinorrhea and nasal obstruction. The symptoms were reported to have started only 3 months earlier. On examination her nasal cavities were filled with necrotic debris and extremely sensitive to touch. In addition, deformity in the form of saddle nose was observed. The soft palate, hard palate, tonsils and posterior oropharyngeal wall were normal. 
The patient initially denied any drug abuse, but reluctantly admitted to habitually snorting a crushed preparation of metham- phetamine for 3 years. A CT scan of the paranasal sinus showed mucoperiostal swelling of all sinuses with necrosis of the nasal septum (Fig 1). The ulcerative process in the patient's nose was rapidly progressive over the following 4 months.
The patient's erythrocyte sedimentation rate was normal and the following tests produced no pathological results: complete blood count, liver and renal function tests, serology for syphilis, bacteriological cultures including stains for fungi and tuberculosis, chest radiograph, extensive urine analysis, examination of rheumatoid factors as well as antinuclear and antimitochondrial tests. In an endoscopic examination a large septal perforation accompanied by excessive necrotic tissues in the nasal space was obvious (Fig 2).
Multiple biopsies of the nose and palate were taken and showed necrosis and ulceration with signs of inflammation, but no evidence for vacuities or granulomatosis (Fig 3). Further testing for antineutrophil cytoplasmic antibodies (C-ANCA) was negative.