# A Case Report of Pseudomonas Infection in a Patient With Nasal Septum Perforation, Cocaine Use Disorder, and a Perinuclear Anti-neutrophil Cytoplasmic Antibody (p-ANCA)-Positive Assay

## TL;DR

A 39-year-old woman with a history of cocaine use developed a nasal septum perforation linked to Pseudomonas infection and a p-ANCA-positive result, highlighting the need for a broad differential diagnosis.

## Contribution

This case report adds a rare clinical scenario linking cocaine use, Pseudomonas infection, and p-ANCA positivity to nasal septum perforation.

## Key findings

- The patient had Pseudomonas aeruginosa and Pseudomonas putida cellulitis.
- A positive p-ANCA assay was observed alongside nasal septum perforation.
- Cocaine use disorder was identified as a contributing factor to the condition.

## Abstract

Nasal septum perforation (NSP) occurs secondary to many underlying etiologies, including facial trauma, drug use, malignancy, infection, or autoimmune disease. We present the case of a 39-year-old female with a past medical history of cocaine use disorder who presented with symptoms concerning facial cellulitis unresponsive to antibiotic therapy. Physical exam and subsequent imaging revealed the presence of NSP. The patient underwent a full workup exploring potential etiologies of NSP in the setting of cocaine use disorder, with lab results indicating Pseudomonas aeruginosa and Pseudomonas putida cellulitis as well as a positive perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) assay. This case highlights the importance of maintaining a broad differential diagnosis for the etiology of NSP and avoiding anchoring bias.