One of the major causes of nasal septum and nasal cavities concha erosion is granulomatosis with polyangiitis which is small to medium size vessel vasculitis. Whenever the disease is suspected based on paranasal sinuses imaging, the lungs and kidneys must be evaluated and vice versa, and both biopsy and serology exam must be done for definitive diagnosis.

The clinical history of this case aid in suspecting the diagnosis, otherwise, there is a wide radiological DD including; chronic sinusitis, fungal sinusitis, sinonasal sarcoidosis, nasal necrosis due to cocaine, and other causes of nasal septal perforation.