Infection

Viral supraglottitis in an adult

February 1, 2009     Ali Lotfizadeh, MD and Dinesh K. Chhetri, MD
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Sinonasal mycetoma

October 31, 2008     Enrique Palacios, MD, FACR, Wesley Jones, MD, and Jorge Alvernia, MD
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Aspergillus otomycosis in an immunocompromised patient

October 31, 2008     Amy L. Rutt, DO and Robert T. Sataloff, MD, DMA
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Abstract

Aspergillus niger, an opportunistic filamentous fungus, was identified as the cause of chronic unilateral otomycosis in a 55-year old, immunocompromised man who had been unresponsive to a variety of treatment regimens. The patient presented with intermittent otalgia and otorrhea and with a perforation of his left tympanic membrane. A niger was identified in a culture specimen obtained from the patient's left ear canal. In immunocompromised patients, it is important that the treatment of otomycosis be prompt and vigorous, to minimize the likelihood of hearing loss and invasive temporal bone infection.

Head and neck manifestations of lymphogranuloma venereum

July 31, 2008     Diana T. Albay, MD and Glenn E. Mathisen, MD
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Abstract

Lymphogranuloma venereum (LGV)—caused by Chlamydia trachomatis serovars L1, L2, or L3—rarely occurs in the United States. The disease clinically manifests in three stages: primary, secondary, and tertiary. The primary manifestation, a self-limited genital ulcer at the site of inoculation, often is absent by the time the patient seeks medical attention. The most common clinical manifestation of LGV is evident in its secondary stage: unilateral tender inguinal and/or femoral lymphadenopathy. However, proctocolitis or inflammatory involvement of perirectal or perianal lymphatic tissues resulting in fistulas and strictures may also occur. The diagnosis of LGV is usually made serologically and by exclusion of other causes of inguinal lymphadenopathy or genital ulcers. Doxycycline is the preferred treatment; it cures the infection and prevents ongoing tissue damage. This case highlights an unusual manifestation of LGV infection—cervical lymphadenopathy following suspected oropharyngeal infection with C trachomatis. Head and neck manifestations of LGV may become an increasing problem in the future if sexual practices such as orogenital contact become more widespread.

An atypical case of fatal zygomycosis: Simultaneous cutaneous and laryngeal infection in a patient with a non-neutropenic solid prostatic tumor

March 1, 2008     Kristine E. Johnson, MD, Kevin Leahy, MD, PhD, Christopher Owens, MD, Joel N. Blankson, MD, PhD, William G. Merz, PhD, and Bradley J. Goldstein, MD, PhD
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Abstract

We describe what we believe is the first reported case of simultaneous highly invasive cutaneous and laryngopharyngeal zygomycosis in a non-neutropenic, nondiabetic but immunosuppressed patient with prostate cancer. An invasive fungal process was not suspected until late in the patient's hospital course; when it was, a tracheotomy and direct laryngoscopic biopsies were performed. Unresectable invasive zygomycosis with Rhizopus rhizopodiformis was diagnosed. The patient was managed with liposomal amphotericin B initially and later with palliative medical therapy until he died. This case emphasizes the need for a rapid and specific diagnosis with timely introduction of appropriate antifungal management, particularly now that voriconazole is frequently used as empiric prophy-laxis against aspergillosis in high-risk patients.

Isolated lingual mucormycosis in an infant with Down syndrome

January 1, 2008     Subhaschandra Shetty, MS, DNB, Usha Kini, MD, DCP, DNB, and Rajeev Joy, MBBS, DLO
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Abstract

Mucormycosis is characterized by severe infection with rapid progression and a high mortality rate. In immunocompromised hosts, the most common type is the rhinocerebral form of mucormycosis. Invasive mucormycosis affecting only the tongue is extremely rare. We report one such case that occurred in an immunocompromised 4-month-old girl with Down syndrome who had been hospitalized for acute gastroenteritis. The infant had metabolic acidosis secondary to diarrhea. It was suspected that the infection had been contracted through the use of a wooden tongue depressor during oral examination. We present this case report in the hope that it will discourage clinicians from using wooden tongue depressors in vulnerable infants. We also wish to emphasize that mucormycosis should be considered in all patients—regardless of age—who pre-sent with localized bluish-black discolored mucosa of the oral mucosa and/or tongue.

Endoscopic view of sinonasal cancer 6 years post-treatment

October 31, 2007     Dewey A. Christmas Jr., MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS
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Laryngeal histoplasmosis as a mimicker of squamous cell carcinoma: Imaging and histologic findings

October 31, 2007     Kenneth Le, MD, Philip J. Daroca Jr., MD, and Enrique Palacios, MD
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Median rhomboid glossitis

September 30, 2007     Brenda L. Nelson, DDS; Lester D.R. Thompson, MD, FASCP
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Median rhomboid glossitis-also known as central papillary atrophy and posterior midline atrophic candidiasis-is a type of erythematous candidiasis unique to the midline posterior tongue. It occurs in as many as 1% of adults.

Cat-scratch disease lymphadenitis

July 31, 2007     Gabriel Caponetti, MD; Liron Pantanowitz, MD
article

Cat-scratch disease is an infectious disease caused primarily by the bacillus Bartonella henselae. Its manifestations can include self-limited regional lymphadenopathy, fever of unknown origin, and visceral organ, neurologic, and ocular involvement. In immunocompromised patients, cat-scratch disease can cause life-threatening systemic disease. This infection generally occurs in young immunocompetent individuals who have been scratched or bitten by a cat; it can also be caused by a flea bite.

 

Comparison of Helicobacter pylori colonization on the tonsillar surface versus tonsillar core tissue as determined by the CLO test

July 31, 2007    
article

Bijan Khademi, MD;
Nika Niknejad, MD;
Behrooz Gandomi, MD;
Firoozeh Yeganeh, MD

Abstract
We conducted a prospective study to determine the correlation between the presence or absence of Helicobacter pylori on the tonsillar surface and in the tonsillar core as determined by the Campylobacter-like organism (CLO) rapid urease enzyme test. Our study population was made up of 55 patients who underwent adenoidectomy, tonsillectomy, or both from December 2002 through April 2003 at Khalili Hospital in Shiraz, Iran. Of these 55 patients, 45 (82%) were positive and 10 (18%) were negative for H pylori colonization as determined by CLO testing. Analysis of samples obtained from individual patients revealed differences in H pylori colonization between tonsillar surface samples and the core tissue samples. Of 106 tonsils obtained from 53 patients who underwent adenotonsillectomy or tonsillectomy, H pylori was found on 56 tonsillar surface samples (53%) and 24 tonsillar core samples (23%); only 13 tonsils (12%) contained H pylori both on the surface and in the core. We conclude that a surface swab is neither specific nor sensitive as an indicator of the presence or absence of H pylori colonization in tonsillar core tissue.

Endoscopic view of an infected concha bullosa

March 31, 2007     Dewey A. Christmas Jr., MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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