A 55-Year-Old Man Comes to the Office Due to Left-Sided

A 55-year-old man comes to the office due to left-sided facial numbness.  His symptoms began a month ago with tingling over his left mid-face and have progressively worsened to complete numbness on that side.  The patient has also had 2 months of headaches, nasal congestion with intermittent epistaxis, and left ear fullness.  He has had no fever, rhinorrhea, or purulent nasal discharge.  The patient has taken over-the-counter allergy medications, but these have provided no relief.  He has no other medical problems and does not use tobacco, alcohol, or illicit drugs.  He recently immigrated to the United States from southern China to be closer to his son.  Temperature is 37 C (98.6 F) , blood pressure is 126/80 mm Hg, and pulse is 84/min.  Examination reveals sensory loss to touch and pain on the left side of the face.  No facial muscle weakness or other neurological findings are present.  Enlarged, nontender, and mobile cervical lymph nodes are palpable bilaterally.  No oropharyngeal or nasal lesions are visualized.  Otoscopy of the left ear demonstrates clear fluid behind the retracted tympanic membrane, but the right ear is normal.  Nasopharyngoscopy reveals a soft-tissue mass in the nasopharynx.  Which of the following is the most likely diagnosis?

A) Granulomatosis with polyangiitis
B) Mucormycosis
C) Nasal polyposis
D) Nasopharyngeal carcinoma
E) Tertiary syphilis

Correct Answer:

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