Granulomatosis with polyangiitis is a necrotizing granulomatous vasculitis that predominantly involves the upper and lower respiratory tracts and the kidneys. Although sinonasal manifestations are common, they are often nonspecific and can mimic benign inflammatory conditions, leading to delayed diagnosis. In contrast, strictly localized disease limited to the nasal septum without systemic involvement is exceptionally rare. We report the case of a 27-year-old woman presenting with persistent nasal obstruction and rhinorrhea. Nasal endoscopy revealed a septal perforation. Computed tomography demonstrated focal nasal septal lysis without paranasal sinus involvement. Laboratory investigations showed markedly elevated c-ANCA levels, and histopathological examination of a septal biopsy confirmed granulomatosis with polyangiitis. Systemic imaging revealed no pulmonary or renal involvement, supporting a localized form of the disease. The patient was treated with systemic corticosteroids and methotrexate, resulting in clinical remission at 5 months. This case highlights the crucial role of imaging in detecting early structural abnormalities and guiding biopsy in atypical presentations of GPA. Early recognition of localized disease is essential to initiate appropriate immunosuppressive therapy and prevent progression to systemic involvement.

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with frequent otolaryngologic manifestations, including nasal septal perforation (NSP) secondary to ischemic necrosis of the septal cartilage. While conservative therapy is often first-line, surgical repair may be indicated in patients with symptomatic or refractory perforations. Limited literature exists regarding septal perforation repair in patients with GPA. We report 1-year postoperative results on the case of a 19-year-old male with a 5-year history of GPA, medically controlled on immunosuppressive therapy, who presented with progressive nasal obstruction, crusting, epistaxis, and whistling. Nasal endoscopy demonstrated a 1.5 × 1.5 cm septal perforation with surrounding mucosal ulceration. After conservative management failed to provide adequate symptom relief, the patient underwent open septorhinoplasty with nasal septal repair using a free temporoparietal fascia (TPF) graft wrapped around a polydioxanone sheet (PDS). The use of a free TPF-PDS composite graft offers structural support, promotes mucosal healing, and has shown promising success rates in non-vasculitic perforations. This case represents the first comprehensive report of successful septal perforation repair utilizing this technique in a medically-managed GPA patient on immunosuppression. TPF-PDS grafting may represent a viable and durable reconstructive option for septal perforation repair in GPA patients with controlled disease. This may also be a promising option for patients with nasal septal perforation in the context of other rheumatologic conditions.

Background: Cardiac erosion after transcatheter closure of secundum atrial septal defect (ASD) is a rare (0.1-0.3%) but potentially life-threatening complication. Available evidence remains limited to isolated case reports and small case series. Methods: A case-based review was conducted in accordance with CABARET recommendations. PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception through January 2026. Adult cases with anatomically confirmed aortic or aorto-atrial erosion after transcatheter closure of a secundum ASD were included. Clinical, anatomical, procedural, imaging, management, and outcome data were synthesized descriptively. An illustrative case with aorto-atrial erosion was included. Results: A total of 40 cases, including the present case, were identified. Median age was 39.5 years, and 27 were female. Chest pain was the most common symptom, reported in 16 cases, whereas six patients were asymptomatic at diagnosis. Median time to erosion was 81 days (range, 0.25-4745 days). A deficient rim was reported in 22 patients, and device oversizing in 17 patients. All erosions involved the aortic wall, most frequently at the atrial roof adjacent to the non-coronary sinus. Aorta-right atrial and aorta-left atrial were the predominant anatomical patterns, reported in 21 and 14 patients, respectively. Surgical intervention was required in 36 cases, which consisted of device explantation with atrial and/or aortic repair. Conclusions: Aortic and aorto-atrial erosion after transcatheter secundum ASD closure is an uncommon but severe complication with heterogeneous clinical presentation and timing. Among published erosion cases, female sex, a deficient retro-aortic rim, device oversizing, and mild aortic root dilation were recurrent characteristics. Careful anatomical assessment, multimodality imaging, and continued follow-up remain essential for early recognition of cardiac erosions.

Cardiac perforation is an uncommon but potentially life-threatening complication of permanent pacemaker implantation. Delayed perforation involving extracardiac structures is rare; left ventricular free-wall perforation with pulmonary extension is exceptionally uncommon and may be diagnostically challenging, especially when pericardial effusion is absent. A 91-year-old man residing on a Greek island developed delayed perforation of the presumed interventricular septal/paraseptal course with exit through the left ventricular free wall and extension toward the left lung after dual-chamber pacemaker implantation for symptomatic high-grade atrioventricular conduction disease/bradyarrhythmia. Initial computed tomography demonstrated a small left pneumothorax and localized pulmonary hematoma without pericardial effusion. The patient subsequently deteriorated with severe bradycardia and pacing instability, requiring pharmacologic chronotropic/hemodynamic support and urgent air transfer to a tertiary cardiac surgical center. Emergency surgical repair via full median sternotomy was performed without cardiopulmonary bypass. The ventricular lead was withdrawn under direct vision from the left ventricular free-wall perforation and then transected under controlled traction. The left ventricular perforation was repaired with polypropylene sutures. Temporary epicardial atrial and ventricular pacing wires were placed to ensure reliable postoperative rhythm support and hemodynamic stabilization. After clinical stabilization, a definitive permanent pacemaker was implanted using the retained atrial lead and a newly placed ventricular lead to restore dual-chamber pacing. There were no clinical signs of device-related or systemic infection before reimplantation. Recovery was uneventful, and at three-month follow-up, the patient remained asymptomatic with normal device function. This case aims to improve recognition of delayed pacemaker lead perforation as a potential cause of clinical deterioration, even in the absence of pericardial effusion. It also underscores the importance of surgical treatment and the use of temporary epicardial pacing when the perforating lead involves extracardiac structures. Finally, it highlights the need for early cross-sectional imaging and a multidisciplinary approach to decision-making, particularly in very elderly patients.

Background: Eyelid reconstruction is particularly challenging because of the delicate anatomy and its critical functional and aesthetic roles. Although various methods have been described for anterior and posterior lamellar repairs, no standardized approach has been established. We developed a single-stage technique integrating reconstruction of both lamellae. Methods: This retrospective case series included seven consecutive patients who underwent full-thickness eyelid reconstruction between 2012 and 2024. Patients were included if they had full-thickness defects requiring reconstruction of both lamellae, underwent reconstruction using a nasal septal chondromucosal graft combined with a large local flap, and had at least 12 months of follow-up. The posterior lamella was reconstructed using nasal septal chondromucosal grafts, and the anterior lamella using large local flaps. Donor sites were managed using various methods. Results: All patients (7/7) achieved complete graft survival without partial or total graft loss. All patients achieved complete eyelid closure without lagophthalmos, and no cases of ectropion, corneal complications, or graft failure were observed. Buccal mucosal grafting demonstrated the most favorable donor-site outcomes, with uneventful healing and no septal perforation or airway-related complications. Conclusions: This single-stage approach combining chondromucosal grafts and local flaps is a feasible and reproducible option for selected patients, providing reliable structural support and satisfactory functional outcomes.