Ulceration of the oropharynx is a very common disorder for otorhinolaryngologists. Its differential diagnosis includes infection, autoimmune response, inflammatory processes, and malignancy. As the ulcer persists over time, it is necessary to perform repeated biopsy for pathologic study and culture for bacteria, fungi, and tuberculosis. Here, we report a case of a 56-year-old man with an initial presentation of chronic ulcer in his oropharynx. He experienced chronic odynophagia and dysphagia intermittently for more than a month, and his response to antibiotics and antifungal treatments was poor. The ulcer had improved initially, but it worsened a month or two later. During a 10-month follow-up period, multiple surveys were conducted, each including blood test, immune and serological test, endoscopic examination, magnetic resonance imaging (MRI), and repeated biopsy. Results were all negative. However, the final biopsy taken over the new onset ulceration in nasopharynx and oropharynx confirmed the diagnosis of extranodal natural killer/T cell lymphoma (ENKL) with systemic involvement of spleen, liver, and skeleton (T4, T5, L1, L2, ribs). He was then referred to our Hematology department for chemotherapy. In summary, the chronic ulcer is one of the clinical manifestations of ENKL. The diagnosis is difficult to make and needs physician’s awareness to repeat the biopsy. (J Taiwan Otolaryngol Head Neck Surg 2023; 58:96-100)
