Infection

Mylohyoid cysticercosis: A rare submandibular mass

October 31, 2009     Ramandeep Singh Virk, MS, Naresh Panda, MS, DNB, FRCS, and Shakuntala Ghosh, MS
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Abstract

Cysticercosis is endemic in developing countries such as India. This infection is acquired via ingestion of cysticerci, the larvae of the Taenia solium (tapeworm, or cestode), in uncooked/undercooked pork or fecally contaminated food or water. Although skeletal muscle commonly harbors the cysticerci, we report a case in which they had infested the mylohyoid muscle in the floor of mouth, a site that has not been mentioned previously in the literature.

Primary sinonasal tuberculosis in a Nigerian woman presenting with epistaxis and proptosis: A case report

August 31, 2009     B. Sulyman Alabi, FWACS, Enoch A.O. Afolayan, FMCPath, A. Abdulakeem Aluko, FWACS, O. Abdulraman Afolabi, MBBS, and F. Grace Adepoju, FWACS
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Abstract

Tuberculosis is the second leading cause of death worldwide after human immunodeficiency virus/AIDS and is especially prevalent in developing countries. We report a case of primary sinonasal tuberculosis without pulmonary involvement, which is rare, in a 27-year old female Nigerian fish farmer. She had a 3-year history of right-eye proptosis, bilateral nasal masses, and epistaxis. Cranial computed tomography suggested an extensive sinonaso-orbital neoplastic lesion. We performed a right external frontoethmoidectomy. Histologically, the excised nasal polyps revealed tuberculosis. Six months of antituberculosis therapy provided satisfactory improvement. Sinonasal tuberculosis, despite its rarity, should be added to the differential diagnosis of nasal and paranasal sinus disorders, and histologic evaluation remains the hallmark of diagnosis. Therapy with a short-duration, multidrug combination, rather than the longer-duration treatment regimen hitherto used, could be quite valuable, especially in the setting of a developing country with poor patient compliance.

Fungal laryngitis

July 31, 2009     Swapna K. Chandran, MD, Karen M. Lyons, MD, Venu Divi, MD, Matthew Geyer, NRCMA, and Robert T. Sataloff, MD, DMA
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Dacryocystitis secondary to an iatrogenic foreign body in the lacrimal apparatus

June 30, 2009     Deepak Gupta, MS, FRCS, Heikki B. Whittet, FRCS, Salil Sood, MS, MRCS, and Suchir Maitra, MS
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Abstract

Dacryocystitis is an infection of the lacrimal sac that is usually caused by obstruction of the nasolacrimal duct. We describe a case of iatrogenic dacryocystitis that occurred secondary to the presence of an impacted piece of a metallic dilator in the lacrimal apparatus. The foreign body was detected on dacryocystography and removed during dacryocystorhinostomy. The patient recovered uneventfully.

Infratemporal fossa abscess: A diagnostic dilemma

April 30, 2009     M. Panduranga Kamath, MS, Kiran M. Bhojwani, MS, Ajit Mahale, MD, Hari Meyyappan, MBBS, and Kumar Abhijit, MBBS
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Abstract

An abscess in the infratemporal fossa is a rare complication of dental extraction. Although it is a recognized entity, only a handful of cases have been reported in the literature. We describe a case of abscess in the infratemporal fossa of a 55-year-old woman with noninsulin-dependent (type 2) diabetes who presented with left-sided facial pain and marked trismus. The abscess was managed successfully with external drainage. We have made an attempt to comprehensively review the literature on this rare condition, with special emphasis on its anatomic complexity and varied clinical presentation, and we provide a detailed discussion of the diagnosis and management of this condition.

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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