Infection

Painful rash of the auricle: Herpes zoster oticus

December 19, 2014     Chao-Yin Kuo, MD; Yuan-Yung Lin, MD; Chih-Hung Wang, MD, PhD
article

A PCR assay in addition to conventional serologic testing provides quick confirmation of the diagnosis of herpes zoster oticus infection.

Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report

July 20, 2015     Rajesh Babu Gollapalli, MBBS, MS(ENT), DORL; Ana Nusa Naiman, FRACS; David Merry, FRACS
article

Abstract

Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

Nasal myiasis: A case report

July 20, 2015     Zrria L. White, MD; Michael W. Chu, MD; Richard J. Hood, MD
article

Abstract

Nasal myiasis is a rare condition, with only a few reported cases and no treatment consensus. We propose a conservative treatment approach with saline irrigation and debridement. Two patients in the ICU of Norfolk General Hospital, a tertiary academic referral center, presented simultaneously with nasal myiasis. Both patients were negative for necrotic masses or tumors, and neither patient had any contributory medical comorbidities. Both patients were treated conservatively with a single dose of pyrantel pamoate, daily sinus irrigation with saline, and daily bedside endoscopic debridement. After 2 days, the nasal myiasis resolved, and both patients recovered without sequelae. We conclude that this conservative, nonsurgical approach to management is both safe and effective.

Maggot infestation of an ulcerated neck wound

June 4, 2015     Sidharth V. Puram, MD, PhD; Margaret S. Carter, MD; Daniel Deschler, MD, FACS
article

The presence of maggots was hardly deliberate in this case, but these larvae successfully debrided a locally recurrent necrotic lymph node.

Conidiobolus coronatus granuloma of the right inferior turbinate: A rare presentation

April 27, 2015     Saurabh Varshney, MBBS, MS; Pratima Gupta, MBBS, MD; Sampan Singh Bist, MBBS, MS; Sanjeev Bhagat, MBBS, MS
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Abstract

Fungal infections are common in tropical countries such as India. Very few clinical cases caused by the Entomophthorales Zygomycetes have been reported. Rhinofacial infection is a rare form of zygomycosis in humans, and only limited information regarding optimal treatment is available. We report here a rare case of rhinofacial Conidiobolus coronatus infection in a previously healthy 18-year-old man who presented with a fungal granuloma of the right inferior turbinate and face. Diagnosis was confirmed by microbiologic culture from a tissue biopsy. The infection was successfully treated with surgery and itraconazole therapy for 12 months. The clinical presentation and treatment of this rare, chronic, indolent form of fungal infection are highlighted in this article.

Potentially lethal pharyngolaryngeal edema with dyspnea in adult patients with mumps: A series of 5 cases

April 27, 2015     Masafumi Ohki, MD; Yuka Baba, MD; Shigeru Kikuchi, PhD; Atsushi Ohata, PhD; Takeshi Tsutsumi, PhD; Sunao Tanaka, MD; Atsushi Tahara, MD; Shinji Urata, MD; Junichi Ishikawa, MD
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Abstract

In this article we describe 5 rare cases of mumps-associated pharyngolaryngeal edema. To the best of our knowledge, this report includes the first case of mumps-associated pharyngolaryngeal edema in a patient who had previously received mumps vaccination, and these cases represent the sixth report of mumps-associated pharyngolaryngeal edema in the English literature. All 5 of our patients with mumps infection were adults and manifested airway stenosis due to pharyngolaryngeal edema. This edema responded favorably to steroid treatment without tracheotomy. We conclude that a pharyngolaryngeal examination is recommended for patients with mumps infection. Steroid treatment is usually effective against pharyngolaryngeal edema; however, in certain cases tracheotomy may be inevitable.

Septic arthritis of the temporomandibular joint caused by Aspergillus flavus infection as a complication of otitis externa

March 2, 2015     Lalee Varghese, MS, DLO, DNB; Rabin Chacko, MDS, FDS, FCPS; George M. Varghese, MD, DNB, DTMH; Anand Job, MS, DLO, MNAMS
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Abstract

Septic arthritis of the temporomandibular joint (TMJ) is a very rare complication of otitis externa that can lead to ankylosis and destruction of the joint. We report the case of a 74-year-old man who developed aspergillosis of the TMJ following otitis externa. To the best of our knowledge, this is the first reported case of TMJ septic arthritis secondary to otitis externa caused by Aspergillus flavus. The patient was successfully managed with condylectomy, debridement, and drug treatment with voriconazole.

Necrotizing tonsillitis caused by group C beta-hemolytic streptococci

March 2, 2015     Jassem M. Bastaki, DMD, MPH
article

Abstract

Tonsillitis and pharyngitis are among the most common infections in the head and neck. Viral tonsillitis is usually caused by enterovirus, influenza, parainfluenza, adenovirus, rhinovirus and Epstein-Barr virus (causing infectious mononucleosis). Acute bacterial tonsillitis is most commonly caused by group A beta-hemolytic streptococci. On the other hand, pseudomembranous and necrotizing tonsillitis are usually caused by fusiform bacilli and spirochetes. Here we report what is, to our knowledge, the first case of necrotizing tonsillitis caused by group C beta-hemolytic streptococci.

Primary laryngeal tuberculosis: An unusual cause of hoarseness

October 17, 2014     Peter Fsadni, MD, MRCP(UK); Claudia Fsadni, MD, MRCP(UK), MSc(Lond); Brendan Caruana Montaldo, MD, FACP
article

Abstract

Tuberculosis (TB) of the larynx is usually associated with concomitant pulmonary TB, but approximately 20% of cases represent primary disease. We report the case of an 85-year-old woman with asthma who presented with a 6-month history of persistent hoarseness. Bronchoscopy confirmed the presence of a lesion in the hemilarynx, and histology identified tuberculoid granulomas that were suggestive of TB. Treatment with a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol led to a complete resolution of symptoms. A high index of suspicion for laryngeal TB is required in patients who present with hoarseness.

A rare occurrence of a fungus ball in the sphenoethmoid recess

October 17, 2014     Jae-Hoon Lee, MD; Ha-Min Jeong, MD
article

A fungus ball usually appears as a calcification within the sinus, suggesting the presence of a foreign body.

Mucormycosis (Mucor fungus ball) of the maxillary sinus

October 17, 2014     Hang Sun Cho, MD; Hoon Shik Yang, MD, PhD; Kyung Soo Kim, MD, PhD
article

Abstract

A fungus ball is an extramucosal fungal proliferation that completely fills one or more paranasal sinuses and usually occurs as a unilateral infection. It is mainly caused by Aspergillus spp in an immunocompetent host, but some cases of paranasal fungal balls reportedly have been caused by Mucor spp. A Mucor fungus ball is usually found in the maxillary sinus and/or the sphenoid sinus and may be black in color. Patients with mucormycosis, or a Mucor fungal ball infection, usually present with facial pain or headache. On computed tomography, there are no pathognomonic findings that are conclusive for a diagnosis of mucormycosis. In this article we report a case of mucormycosis in a 56-year-old woman and provide a comprehensive review of the literature on the “Mucor fungus ball.” To the best of our knowledge, 5 case reports (8 patients) have been published in which the fungus ball was thought to be caused by Mucor spp.

Bilateral nontuberculous mycobacterial middle ear infection: A rare case

September 17, 2014     Ing Ping Tang, MS; Shashinder Singh, MS; Raman Rajagopalan, MS
article

Abstract

Nontuberculous Mycobacterium (NTM) middle ear infection is a rare cause of chronic bilateral intermittent otorrhea. We report a rare case of bilateral NTM middle ear infection in which a 55-year-old woman presented with intermittent otorrhea of 40 years' duration. The patient was treated medically with success. We conclude that NTM is a rare but probably under-recognized cause of chronic otitis media. A high index of suspicion is needed for the diagnosis to avoid prolonged morbidity. Treatment includes surgical clearance of infected tissue with appropriate antimycobacterial drugs, which are selected based on culture and sensitivity.

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