Infection

The association between Helicobacter pylori and laryngopharyngeal reflux in laryngeal pathologies

March 1, 2012     Engin Çekin, MD, Mustafa Ozyurt, PhD, Evren Erkul, MD, Koray Ergunay, MD, Hakan Cincik, MD, Burak Kapucu, MD, and Atila Gungor, MD
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Abstract

We conducted a study to determine the presence or absence of Helicobacter pylori and laryngopharyngeal reflux (LPR) in 43 previously untreated patients who had presented with a laryngeal lesion. Our aim was to determine if there was any association among H pylori, LPR, and laryngeal lesions. H pylori status was determined by real-time polymerase chain reaction (PCR) assays of biopsy tissue obtained during direct laryngoscopy. The presence or absence of LPR was determined on the basis of patients' reflux symptom index (RSI) and reflux finding score (RFS), which were based on their questionnaire responses and findings on endoscopic examination of the larynx, respectively. Patients with an RSI of 14 or more and/or an RFS of 8 or more were considered to have LPR. H pylori was present in 24 patients (55.8%) and absent in 19 (44.2%)-not a statistically significant difference. The prevalence of LPR was higher than the prevalence of H pylori; it was present in 30 patients (69.8%) and absent in 13 (30.2%). The difference was statistically significant (p = 0.01). We found no association between H pylori status and LPR status. Additionally, we analyzed two subgroups based on whether their lesions were benign or malignant/premalignant and found a significant relationship between LPR positivity and the presence of malignant/premalignant laryngeal lesions (p = 0.03). We found no association between H pylori status and either of the two subgroup categories.

Acquired toxoplasmosis of the buccal area with extranodular involvement: Report of an unusual case

December 1, 2009     Serap Köybasi, MD, Ahmet Emre Süslü,w, MD, Beyhan Yigit, MD, and Cetin Boran, MD
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Abstract

Acquired toxoplasmosis is a common parasitic infection in humans. It can be caused by ingestion of infected meat or other food that has been contaminated by the feces of infected cats. Approximately 90% of immunocompetent patients with acquired toxoplasmosis are asymptomatic and undiagnosed; in the other 10%, toxoplasmosis manifests as a nonspecific, self-limited illness that usually does not require treatment. In symptomatic cases, cervical lymphadenopathy is one of the most common clinical findings. We report the case of a 33-year-old woman who experienced unilateral facial swelling secondary to toxoplasmosis. In addition to the atypical location of her disease (i.e., the buccal area), the atypical histopathologic findings in this case (e.g., extranodular involvement) constituted a very unusual presentation of toxoplasmosis.

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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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.

Sinonasal mycetoma

October 31, 2008     Enrique Palacios, MD, FACR, Wesley Jones, MD, and Jorge Alvernia, MD
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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.

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