1/19. Acquired immune deficiency syndrome (AIDS) presenting as a nasal septal perforation.patients infected with the Human Immunodeficiency Virus (HIV) and those with AIDS may present with many head and neck manifestations. We report a case of an undiagnosed HIV positive male who presented with symptoms due to a nasal septal perforation, and rapidly developed AIDS. The histopathology of the perforation margins revealed active chronic inflammation with no evidence of neoplasia or granuloma. No viral or fungal infection was demonstrable on immunological testing and fungal stain. This is the first reported case of a patient developing AIDS presenting with a nasal septal perforation.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
2/19. survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient.OBJECTIVE: Rhino-orbital-cerebral mucormycosis is usually associated with a poor prognosis and is almost exclusively seen in immunocompromised patients. We report the third documented case of rhino-orbital-cerebral mucormycosis caused by Apophysomyces elegans (a new genus of the family Mucoraceae first isolated in 1979) in an immunocompetent individual. Orbital exenteration and radical debridement of involved adjacent structures combined with intravenous liposomal amphotericin resulted in patient survival. DESIGN: Interventional case report. METHOD: A 59-year-old immunocompetent white man sustained a high-pressure water jet injury to the right inner canthus while cleaning an air conditioner filter. He later had "orbital cellulitis" develop that did not respond to antibiotics and progressed to orbital infarction. Imaging studies and biopsy results led to a diagnosis of mucormycosis. Tissue culture grew Apophysomyces elegans, a new genus of the family Mucoraceae first isolated in 1979. Orbital exenteration and radical debridement of involved adjacent structures, combined with intravenous liposomal amphotericin, resulted in patient survival. RESULTS: After orbital exenteration and debridement of involved adjacent structures along with intravenous liposomal amphotericin, our patient has remained free from relapse with long-term follow-up. CONCLUSIONS: The agent causing this case of rhino-orbital-cerebral mucormycosis (Apophysomyces elegans) contrasts with the three genera most commonly responsible for mucormycosis (rhizopus, Mucor, and absidia) in that infections with this agent tend to occur in warm climates, by means of traumatic inoculation, and in immunocompetent patients. Rhino-orbital-cerebral mucormycosis should be considered in all patients with orbital inflammation associated with multiple cranial nerve palsies and retinal or orbital infarction, regardless of their immunologic status. A team approach to management is recommended for early, appropriate surgery and systemic antifungal agents.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
3/19. nasal septal perforation: a rare extraintestinal manifestation of Crohn's disease.Nasal manifestations of Crohn's disease are quite rare. They are typified by chronic mucosal inflammation, obstruction, bleeding, and occasionally septal perforation--signs and symptoms that are common to many disease states of the nose. Nasal findings, much like oral lesions, can precede the more typical gastroenterologic manifestations of Crohn's disease. Otolaryngologists should be aware of such an association and consider the diagnosis of Crohn's disease in atypical cases of nasal disease. We report the case of a 12-year-old boy who had severe Crohn's disease and a nasal septal perforation, and we discuss this complication in the context of its otolaryngologic manifestations.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
4/19. Multiple bilateral orbital abscesses secondary to nasal furunculosis.Orbital inflammation secondary to sinus inflammation is a well known entity and has been widely reported. However, nasal furunculosis resulting in orbital inflammation is a rare occurrence. We present a case of a 2-year-old boy who developed multiple bilateral orbital abscesses secondary to nasal furunculosis. To our knowledge such a case has not been reported before.- - - - - - - - - - ranking = 3keywords = inflammation (Clic here for more details about this article) |
5/19. Sinonasal osteocartilaginous necrosis in cocaine abusers: experience in 25 patients.BACKGROUND: cocaine-induced lesions may cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate that mimics the clinical picture of other diseases. methods: From January 1991 to September 2001 25 patients with cocaine-induced midline destructive lesions were observed at the Department of Otorhinolaryngology of the University of Brescia. The diagnosis was based on physical and endoscopic evaluation, routine blood and urine analysis, radiological findings, and repeated biopsies of the nasal mucosa. serum was analyzed by the antineutrophilic cytoplasmic antibody (ANCA) test using indirect immunofluorescence and by enzyme-linked immunosorbent assay for antibodies against proteinase 3 and myeloperoxidase. RESULTS: Septal perforation was present in all 25 patients, 16 of which (68%) also had partial destruction of the inferior turbinate. Hard palate reabsorption was observed in only six patients (24%); in two of these patients, the lesion also extended to the soft palate. Fourteen patients (56%) were positive by the immunofluorescence test (nine patients had a P-ANCA and five patients a C-ANCA pattern). Four patients (16%) with the P-ANCA pattern and all patients with the C-ANCA pattern also tested positive for anti-proteinase 3 antibodies. CONCLUSION: Any sinonasal inflammation involving the midline that persists or remains refractory to treatment may be the first manifestation of potentially lethal drug addiction. cocaine abuse should be considered in the differential diagnosis of destructive lesions of the nasal cavity even in the presence of a positive ANCA test.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
6/19. Respiratory epithelial adenomatoid hamartoma associated with nasal polyposis.hamartoma is a rare, non-neoplastic tumor characterized by an abnormal mixture of tissues, which are indigenous to the region. They are rare in the nasal cavity. We report a 79-year-old woman with an adenomatoid hamartoma in the left nasal cavity associated with nasal polyposis. This association supports the hypothesis that inflammation is one of the factors that induce the development of a hamartoma. Functional endoscopic sinus surgery was performed to completely remove it, and this lesion was found to have arisen from the lateral nasal wall. It is an unusual localization because the most common site in the nasal cavity is the nasal septum, particularly the posterior aspect. Limited but complete surgical resection is the treatment of choice. Although adenomatoid hamartoma arising from the sinonasal tract is very rare, head and neck surgeons should be aware of this pathological entity as a differential diagnosis for inverted papilloma and adenocarcinoma. Misinterpretation of these lesions as a true neoplasm may result in unnecessarily aggressive surgery for this benign lesion.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
7/19. Nasal chondromesenchymal hamartoma in older children and adults: series and immunohistochemical analysis.CONTEXT: Nasal chondromesenchymal hamartoma is a benign mass lesion of the nasal cavity predominantly described in young infants. These unusual lesions are composed of a proliferation of mesenchymal and cartilaginous elements. Their pathogenesis is unknown, but they may be derived from embryologic rests. To our knowledge, only 1 case in an older child has been reported, and no cases have been reported in adults. OBJECTIVE: To report 4 cases of nasal chondromesenchymal hamartoma occurring in older children and adults, including immunohistochemical analysis of these unusual lesions. DESIGN: Cases identified from our archives were examined to confirm the diagnosis of nasal chondromesenchymal hamartoma. Immunohistochemical analysis was performed using a panel of antibodies (epithelial membrane antigen, smooth muscle actin, all muscle actin, cytokeratin, S100, and KP1) to evaluate for epithelial, smooth muscle, neural, chondroid, and histiocytic differentiation. RESULTS: Four cases of nasal chondromesenchymal hamartoma in patients of 11, 69, 17, and 25 years of age demonstrated histologic evidence of mesenchymal and cartilaginous elements underlying a chronically inflamed respiratory mucosa. Bony and adipose elements and rare glandular elements were interspersed. Cartilaginous elements stained strongly with S100, whereas mesenchymal regions showed variable and weaker staining. Smooth muscle differentiation was seen primarily in the mesenchymal areas. Epithelial membrane antigen was focally positive in all cases. CONCLUSIONS: Nasal chondromesenchymal hamartomas can rarely occur in the older child and adult. Mesenchymal areas show both myofibroblastic and cartilaginous differentiation. We speculate that inflammation or a recapitulation of developmental signals may be components in the pathogenesis of these lesions.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
8/19. Rhino-orbitocerebral mucormycosis caused by Apophysomyces elegans.Rhino-orbitocerebral mucormycosis (ROCM) caused by more common zygomycetes (e.g., Mucor) is known to cause rapidly fatal infections in immunocompromised patients. Apophysomyces elegans is an emerging zygomycete that has been reported to cause invasive cutaneous and rhino-orbitocerebral infections in immunocompetent individuals. Limited data exist describing the syndrome of ROCM caused by A. elegans. We describe a recent case and performed a comprehensive literature review to delineate the clinical characteristics of ROCM caused by A. elegans. Our case is a 50-year-old man with diabetes mellitus who presented with facial pain and right eye proptosis. Endoscopic sinus sampling revealed A. elegans. He was treated with liposomal amphotericin b and multiple debridements, with no disease on 1.5-year follow-up examination. Seven cases were identified on literature review, including the present case. Most patients (86%) were male, with a mean age of 40 years. Most patients (71%) did not have predisposing medical conditions. Three patients had predisposing head trauma. All presented with facial and/or periorbital pain. All had magnetic resonance imaging or computed tomography of the head showing intraorbital and/or sinus inflammation. diagnosis was confirmed by histopathology and deep tissue culture in all cases. All patients required eye exenteration and extensive surgical debridement, in addition to intravenous amphotericin b. Six of the seven patients (86%) recovered. ROCM caused by A. elegans is rarely reported in the literature. Most such infections occurred in immunocompetent patients, often after facial trauma. survival in ROCM caused by A. elegans is favorable in reported cases, with prompt surgical debridement and antifungal therapy.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
9/19. Nasal cocaine abuse causing an aggressive midline intranasal and pharyngeal destructive process mimicking midline reticulosis and limited Wegener's granulomatosis.We describe a 36-year-old white man with an aggressive, midline intranasal and naso and oropharyngeal destructive process temporally associated with heavy (3 g/week) abuse of nasal cocaine. necrosis and atrophy of the inferior and middle nasal turbinates bilaterally, prominent naso and oropharyngeal ulcers, and nasal septal perforation were observed clinically. Biopsies of a necrotic posterior oropharyngeal ulcer revealed focal areas of chronic inflammation and necrosis, but there was no evidence of vasculitis or granuloma formation. serum was negative for antineutrophil cytoplasmic antibody. The oropharyngeal ulcer improved with abstinence from cocaine. nasal septal perforation is a well recognized complication of nasal cocaine insufflation. Our case illustrates that a more aggressive midline intranasal and intrapharyngeal destructive process mimicking limited Wegener's granulomatosis and midline reticulosis can be associated with nasal cocaine abuse.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
10/19. Aggressive intranasal carcinoma mimicking infection or inflammation.In a twenty-year period we have treated five patients with intranasal squamous cell carcinomas who initially were thought to have benign cutaneous disorders of the nasal skin. Advanced squamous cell carcinoma requiring total rhinectomy, often with extensive contiguous midface excision, was found in all patients. Three of these five patients died of their disease. In one patient, a red nose resembling acne rosacea was present. In the four others, chronic cellulitic or ulcerative cutaneous involvement was caused by squamous cell carcinoma. These cases emphasize the need for intranasal examination and appropriate radiologic studies to exclude intranasal carcinoma in patients with apparently unresponsive cutaneous nasal disease.- - - - - - - - - - ranking = 4keywords = inflammation (Clic here for more details about this article) |
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