1/5. Cutaneous and paranasal aspergillosis in an immunocompetent patient.A 26-year-old Libyan woman presented with asymptomatic nodulo-ulcerative skin lesions present for 1 year. Three years prior to presentation, she had experienced a nasal discharge followed by the development of a nodule in the nasal cavity and a plaque on the hard palate. These lesions had gradually increased in size and ulcerated, resulting in perforation of the nasal septum and palate. Two years later, the patient noticed the appearance of skin lesions: a nodule on the right thumb and numerous nodulo-ulcerative lesions on the extremities. General physical examination was normal with no significant lymphadenopathy. Examination of the oral cavity revealed perforation of the distal nasal septum, with a perforated nodular plaque involving the entire palate, associated with subluxation of the upper incisors (Fig. 1a). On skin examination, multiple firm nodules and nodulo-ulcerative lesions with a central eschar and raised margins were observed. The lesions ranged in size from 0.5 to 5 cm and were distributed on the right hand and fingers, left upper arm (Fig. 1b), left calf, and right thigh. Routine laboratory investigations (liver function tests, serum calcium, electrolytes, lipid profile, urine and stool culture studies) were normal. immunoelectrophoresis disclosed normal levels of immunoglobulins IgG, IgA, and IgM. Serologic studies for human immunodeficiency virus (hiv) and syphilis, and a tuberculin test, were all negative. A Giemsa-stained tissue smear was negative for leishmania tropica organisms. Radiological studies disclosed a slight haziness of the maxillary sinuses with perforation of the nasal septum. A chest X-ray was normal. Histopathologic examination of biopsies taken from both the palate and from ulcerated and nonulcerated skin lesions was performed, and all showed similar findings. The biopsy of a nonulcerated skin lesion showed pseudoepitheliomatous epidermal hyperplasia with neutrophilic microabscesses (Fig. 2a). A dermal diffuse and nodular granulomatous mixed infiltrate of lymphocytes, histiocytes, giant cells, numerous eosinophils, and neutrophilic microabscesses was seen in all tissues examined. Septate hyphae were present both within giant cells and free in the dermis (Fig. 2b). The hyphae were branching at a 45 degrees angle and were positive on periodic acid-Schiff and Grocott methenamine silver stains (Fig. 2c). Fungal culture studies of material taken from an ulcerated skin lesion grew aspergillus flavus. blood cultures were negative for Aspergillus sp. or other microorganisms. The patient was treated with intravenous amphotericin b, but the medication was discontinued due to her intolerance to the drug. She was subsequently lost to follow-up.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. mucocele-like lesions of the sphenoid sinus with hypointense foci on T2-weighted magnetic resonance imaging.Lesions limited to the sphenoid sinus are relatively rare, and are obscure with respect to symptoms and physical findings. The differential diagnosis of isolated sphenoid sinus disease includes bacterial sinusitis, fungal infection, granulomatous inflammation, mucocele, and tumors. magnetic resonance imaging (MRI) can provide information that closely reflects the composition of the tissues, sometimes permitting differentiation between pathologically distinct lesions showing similar density by computed tomography. We describe two cases involving mucocele-like lesions of the sphenoid sinus where preoperative MRI revealed a focus of hypointensity within the lesions. In both patients the sphenoid sinus was opened by a transnasal endoscopic approach, and diseased tissue corresponding to the hypointense area was removed under direct endoscopic vision. Histopathological diagnosis revealed colonies of Aspergillus in one case and necrotic granulation tissue without fungus in the other. We concluded that MRI is a crucial part of preoperative evaluation and that the transnasal endoscopic approach represents a safe and effective method for treating nonmalignant isolated sphenoid sinus disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. cholesterol granuloma of the maxillary sinus resembling an invasive, destructive tumor.The case of a maxillary sinus cholesterol granuloma posing as a malignant tumor is presented. The patient was referred to the authors' clinic with symptoms typical of maxillary sinusitis, but physical examination suggested the presence of neoplasm. radiology also resulted in confusing, tumor-like pictures. Histological examination of a preoperative tissue sample identified the process as a cholesterol granuloma, which was removed by a classic Caldwell-Luc operation. The patient has been symptom free since the operation. The pathogenesis of cholesterol granuloma is described, and the problems of establishing a diagnosis without preoperative histology are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. Antroscleroma.Oedema, hypertrophy, polyposis, atrophy or empyema of the maxillary sinus are common features of rhinoscleroma. However, actual involvement of the antrum by the nasal granuloma is rare and primary scleroma of the antrum is of extreme rarity. Three cases of antroscleroma are presented, one secondary to an extensive rhinoscleroma and two primary. The difference in the physical, biological and microbiological environment in the antrum from that in the nose might explain the rarity of antroscleroma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. Septic thrombosis of orbital vessels due to cutaneous nasal infection.The authors describe two cases of cutaneous nose infection that quickly spread and extended to the orbital venous complex. At first glance, the clinical presentation could be mistaken for a complicated sinusal infection; therefore, the evaluation of the sinuses, by means of physical examination and radiological investigation, was of great concern, showing that there was no important pathology in the sinuses. The CT scan and the color Doppler imaging (orbital ultrasound with Doppler) demonstrated, throughout the development of the disease, that the superior ophthalmic vein was affected in both patients and the cavernous sinus in one of them. On physical examination, chemosis of the conjunctiva, proptosis, and edema of the eyelids were prominent. patients improved only after appropriate intravenous antibiotic therapy against staphylococcus (clindamycin) and corticosteroids, making one conclude that treatment of this disease should be initiated as soon as possible in order to decrease morbidity and mortality.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |