scholarly journals Basilar Artery Territory Stroke Secondary to Invasive Fungal Sphenoid Sinusitis: A Case Report and Review of the Literature

2015 ◽  
Vol 7 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Katherine A. Fu ◽  
Peggy L. Nguyen ◽  
Nerses Sanossian
Keyword(s):  
Case Report ◽  
Basilar Artery ◽  
Early Recognition ◽  
Altered Mental Status ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Comfort Care ◽  
Signal Abnormality ◽  
History Of ◽  
Cerebellar Infarct

Background: Mucormycosis is a fungal infection with the following 5 classic forms: cutaneous, pulmonary, gastrointestinal, disseminated, and rhinocerebral. The rhinocerebral form can be rapidly progressive and invasive with a high mortality rate. We present a case of a 38-year-old man with invasive mucormycosis that led to a basilar artery territory stroke. Rhinocerebral mucormycosis is an unusual cause of stroke. Case Report: A 38-year-old man with a past medical history of diabetes mellitus presented with altered mental status. A lumbar puncture revealed eosinophilic pleocytosis with a mildly elevated total protein and borderline low glucose level. CT revealed a left medullary and cerebellar infarct confirmed by MRI. MRI also displayed a diffuse marrow signal abnormality in the clivus with contiguous sinus disease. Endoscopic sinus surgery confirmed that the fungal sinusitis was mucormycosis of the Rhizopus genus, which had affected the left sphenoid sinus, invaded through the skull base, and involved the basilar artery. He was given liposomal amphotericin (500 mg i.v.) with posaconazole (400 mg i.v. twice daily). Due to the severity of the invasion and poor prognosis, the patient was discharged with comfort care measures. Discussion: Clinicians should be aware of invasive sinusitis as a rare cause of stroke in diabetics. Once the subarachnoid space and basal arteries of the brain have been invaded, the prognosis is very poor. The key to improvement of outcomes is early recognition and treatment, and examination of the sinuses on neuroimaging in all cases of stroke is vital.

scholarly journals 714. Invasive Fungal Infection Caused by Curvularia Species in a Patient with Intranasal Drug Use: A Case Report

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S456-S457
Author(s):  
Bakri Kulla ◽  
Jason Pham ◽  
McKenna Johnson
Keyword(s):  
Case Report ◽  
Head And Neck ◽  
Mental Status ◽  
Sphenoid Sinus ◽  
Altered Mental Status ◽  
The United States ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
History Of ◽  
Curvularia Species

Abstract Background Invasive fungal infections (IFIs) are uncommon infections that account for approximately 27.2/100,000 cases per year in the United States. One form of IFI is chronic invasive fungal sinusitis (CIFS). If untreated, invasion into neighboring structures may cause altered mental status, seizures, strokes, proptosis, and intracranial complications. Case Report An afebrile 43-year-old female with a history of polysubstance abuse presented to the ED due to altered mental status, left sided facial droop, right sided hemiparesis, and slurred speech. The patient was somnolent but arousable to stimuli and appeared acutely ill. The patient’s mother reported a history of cocaine abuse, which was confirmed on urine toxicology. A CT head and neck with contrast revealed subacute basal ganglia lacunar infarcts and a left sphenoid opacity with scattered hyperintensities and erosive changes [Figure 2]. One month prior, she had been diagnosed with a left superior pole kidney mass and a left-sided enlarged periaortic lymph node containing multiple noncaseating granulomas and GMS stains positive for fungal hyphae [Figure 1]. The patient underwent nasal endoscopy with tissue biopsy. Tissue showed necrotizing invasive fungal sinusitis with granuloma formation and foreign-body giant cell reaction. Fungal speciation of the tissue culture showed Curvularia species was placed on IV voriconazole. While the infection stabilized, her neurologic deficits did not significantly improve. She was discharged to inpatient rehabilitation. Figure 1. Coronal and axial view of left upper pole kidney mass with perinephric fat stranding. Figure 2. MRI brain CTA Head and Neck with contrast in axial plane showing multifocal infarcts likely represent complications of fungal basilar meningitis secondary to the left sphenoid sinus disease. Imaging also shows irregular erosive change at the anterior aspect of the sella turcica, through the planum sphenoidale, and bony defect of the sphenoid sinus. Methods Results Conclusion Intranasal use of cocaine causes vasoconstriction to elicit sinonasal tissue ischemia. With extended use, chronic mucosal inflammation can occur that can result in sinonasal osteocartilaginous necrosis and potential for infection. CIFS is infrequently diagnosed and its indolent nature with progression over weeks or months can make diagnosis and treatment difficult. The most frequent fungal species identified are the Aspergillus species, but Curvularia species have been found as well. CT and MRI scanning can be suggestive, but are not sufficiently specific or sensitive. The main forms of interventional modalities include surgical debridement and antifungal therapy to maximize survival Disclosures All Authors: No reported disclosures

Pneumatisation of turbinates and paranasal sinuses in children: case report

2013 ◽  
Vol 127 (4) ◽  
pp. 419-422 ◽  
Author(s):  
K Tsioulos ◽  
M Martinez Del Pero ◽  
C Philpott
Keyword(s):  
Case Report ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Image Guidance ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
Nasal Blockage ◽  
History Of ◽  
Maximal Medical Therapy ◽  
Tomography Scan

AbstractObjective:To describe a rare case of multiple anatomical variations in the sinonasal skeleton of an adolescent with chronic rhinosinusitis, together with its successful surgical management.Case report:A 15-year-old male adolescent was referred with a 3-year history of nasal blockage and hyposmia. His symptoms did not improve on maximal medical therapy. A pre-operative computed tomography scan revealed numerous anatomical variations in his nose and paranasal sinuses. He underwent neuronavigation-assisted endoscopic sinus surgery without complication, and with subsequent resolution of his symptoms at 10 months.Conclusion:Chronic rhinosinusitis in children offers its own set of unique surgical challenges. The effectiveness and safety of sinus surgery in this population can be improved through the knowledge of anatomical variants, and is aided by the use of image guidance systems.

scholarly journals A 7-Year History of Necrobiotic Xanthogranuloma following Asymptomatic Multiple Myeloma: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Siriluk Inthasotti ◽  
Rungsima Wanitphakdeedecha ◽  
Jane Manonukul
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Monoclonal Gammopathy ◽  
Early Recognition ◽  
Strong Association ◽  
Hematologic Malignancies ◽  
Morbidity And Mortality ◽  
Wound Complications ◽  
History Of ◽  
Progressive Course

Necrobiotic xanthogranuloma (NXG) is a rare destructive xanthomatous granuloma with chronic, indolent, and progressive course. The morbidity and mortality are the results from wound complications and associated disorders. Because of its strong association with monoclonal gammopathy and multiple myeloma, early recognition of disease is mandatory to monitor and prevent systemic involvements of hematologic malignancies.

scholarly journals Frontal Sinus Cholesterol Granuloma: Case report

2014 ◽  
Vol 5 (1) ◽  
pp. ar.2014.5.0073 ◽  
Author(s):  
Nicholas L. Deep ◽  
Mohamad R. Chaaban ◽  
Ajaz L. Chaudhry ◽  
Bradford A. Woodworth
Keyword(s):  
Case Report ◽  
Minimally Invasive ◽  
Frontal Sinus ◽  
Male Subject ◽  
Sinus Surgery ◽  
Cholesterol Granuloma ◽  
Cystic Lesions ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
History Of

A case report of a massive cholesterol granuloma (CG) of the frontal sinus in a 15-year-old male subject treated endoscopically is reported. CGs are slowly expanding, cystic lesions that are rarely observed in the frontal sinus. Frontal sinus CGs characteristically present with proptosis, diplopia, and a unilateral painless expanding mass above the orbit. Patients frequently report a history of chronic nasal obstruction or head trauma. Although the pathogenesis is unclear, it is likely multifactorial in etiology. Surgical resection via endoscopic sinus surgery has been gaining popularity because of the minimally invasive approach and lower rates of recurrence.

scholarly journals Euglycemic Diabetic Ketoacidosis in Type 1 Diabetes on Insulin Pump, with Acute Appendicitis: A Case Report

2021 ◽  
Vol 5 (3) ◽  
pp. 296-298
Author(s):  
Brian Thompson ◽  
Anthony Kitchen
Keyword(s):  
Type 1 Diabetes ◽  
Case Report ◽  
Acute Appendicitis ◽  
Diabetic Ketoacidosis ◽  
Insulin Pump ◽  
Point Of Care ◽  
Altered Mental Status ◽  
History Of ◽  
Euglycemic Diabetic Ketoacidosis

Introduction: Recently, euglycemic diabetic ketoacidosis has been an increasing topic of discussion within emergency medicine literature. Euglycemic diabetic ketoacidosis can easily be missed, as a normal point-of-care glucose often mistakenly precludes the work-up of diabetic ketoacidosis. Case Report: A 16-year-old female with a past medical history of type 1 diabetes presented to the emergency department with altered mental status, vomiting, and abdominal pain. She was diagnosed with euglycemic diabetic ketoacidosis. Conclusion: Reported cases of euglycemic diabetic ketoacidosis are most frequently attributed to sodium glucose cotransporter-2 inhibitors, but other potential causes have been discussed in the literature. In this patient, a starvation state with continued insulin use in the setting of acute appendicitis led to her condition.

scholarly journals A Case Report of Steroid Responsive Nivolumab-Induced Encephalitis

2017 ◽  
Vol 24 (5) ◽  
pp. 107327481772906 ◽  
Author(s):  
Kaja Richard ◽  
Jacqueline Weslow ◽  
Stephanie L. Porcella ◽  
Sowmya Nanjappa
Keyword(s):  
Mental Status ◽  
Checkpoint Inhibitors ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Oral Steroid ◽  
Gradual Improvement ◽  
Stage 4 ◽  
History Of ◽  
Intravenous Steroids

Nivolumab (Opdivo) approval for the treatment of non-small cell lung cancer (NSCLC) prompts recognition of its future use in various cancers. Although rare, occurring in 1% to 3% of treated cases, nivolumab along with other immune checkpoint inhibitors are associated with immune-related encephalitis. With its prospective use, nivolumab-induced encephalitis illustrates the necessity of early recognition and successful management to decrease morbidity and mortality. We describe a treated case of nivolumab-induced encephalitis. A 74-year-old male with a history of stage 4 squamous NSCLC presenting with insidious altered mental status following his first dose of nivolumab. After an extensive workup that proved negative, the patient received intravenous steroids with gradual improvement of mental status. Patient subsequently returned to baseline and was discharged with oral steroid taper. Nivolumab-induced encephalitis is a diagnosis of exclusion with nonspecific signs and symptoms. Immediate recognition of patients prescribed nivolumab chemotherapy could potentially prevent fatal complications of neurotoxicity.

scholarly journals Group a streptococcal cellulitis in the early puerperium

2011 ◽  
Vol 68 (7) ◽  
pp. 607-610
Author(s):  
Branka Nikolic ◽  
Ana Mitrovic ◽  
Svetlana Dragojevic-Dikic ◽  
Snezana Rakic ◽  
Zlatica Cakic ◽  
...  
Keyword(s):  
Case Report ◽  
Toxic Shock Syndrome ◽  
Early Recognition ◽  
Healthy Woman ◽  
Supportive Therapy ◽  
Streptococcal Toxic Shock Syndrome ◽  
Toxic Shock ◽  
Short Period ◽  
History Of ◽  
Group A

Introduction. Infectious diseases caused by Streptococcus pyogenes, a member of the group A Streptococci (GAS) are among the most common life threatening ones. Patients with GAS infections have a poor survival rate. Cellulitis is a severe invasive GAS infection and the most common clinical presentation of the disease associated with more deaths than it can be seen in other GAS infections. According to the literature data, most cases of GAS toxic shock syndrome are developed in the puerperium. However, there are two main problems with GAS infection in early puerperium and this case report is aimed at reminding on them. The first problem is an absence of awareness that it can be postpartal invasive GAS infection before the microbiology laboratory confirms it, and the second one is that we have little knowledge about GAS infection, in general. Case report. A 32- year-old healthy woman, gravida 1, para 1, was hospitalized three days after vaginal delivery with a 38-hour history of fever, pain in the left leg (under the knee), and head injury after short period of conscious lost. Clinical picture of GAS infection was cellulites. Group A Streptoccocus pyogenes was isolated in vaginal culture. Rapid antibiotic and supportive treatment stopped development of streptococcal toxic shock syndrome (STSS) and potential multiorganic failure. Signs and symptoms of the infection lasted 25 days, and complete recovery of the patient almost 50 days. Conclusion. In all women in childbed with a history of fever early after delivery, vaginal and cervical culture specimens should be taken as soon as possible. Early recognition of GAS infection in early puerperium and prompt initiation of antimicrobial drug and supportive therapy can prevent development of STSS and lethal outcome.

Pneumocephalus and orbital emphysema associated with the use of an autoinflation device: a unique case report and review of the literature

2019 ◽  
Vol 133 (2) ◽  
pp. 157-160
Author(s):  
A J Millington ◽  
V Perkins ◽  
M A Salam
Keyword(s):  
Case Report ◽  
Otitis Media ◽  
Eustachian Tube ◽  
Endoscopic Sinus Surgery ◽  
Otitis Media With Effusion ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Orbital Emphysema ◽  
Tube Dysfunction ◽  
History Of

AbstractBackgroundAutoinflation devices are commonly used for otitis media with effusion and Eustachian tube dysfunction. Generally, these are very safe devices, with few or no complications.Case reportThis paper presents a case study of pneumocephalus and orbital emphysema, associated with the use of an autoinflation device, in a 73-year-old woman with Eustachian tube dysfunction and otitis media with effusion, and a history of extensive endoscopic sinus surgery 13 years previously.ConclusionA literature review showed autoinflation-related pneumocephalus in patients with skull base defects relating to cranial surgery or tumours; however, this has not been described previously with the Otovent system or its use in relation to functional endoscopic sinus surgery. Given the theoretical risk of undetected bony abnormalities in post-operative functional endoscopic sinus surgery patients, it is suggested that autoinflation devices are used cautiously in patients with a history of sinus surgery.

scholarly journals Acute Demyelinating Encephalomyelitis Following Measles Infection Due to Vaccine Failure: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 171-173
Author(s):  
Robert McMickle ◽  
Lauren Fryling ◽  
Ross Fleischman
Keyword(s):  
Case Report ◽  
Altered Mental Status ◽  
Acute Disseminated Encephalomyelitis ◽  
International Travel ◽  
Vaccine Failure ◽  
Lower Extremity Weakness ◽  
Vaccination Rates ◽  
Acute Encephalitis ◽  
History Of ◽  
New Onset

Introduction: Local outbreaks of measles infection are primarily mediated by international travel of persons from endemic areas, with subsequent spread of the virus via undervaccinated populations. Recent resurgences of measles in communities where vaccination rates are non-ideal secondary to philosophical objections require the emergency physician to more routinely consider the diagnosis. In cases of measles complicated by acute encephalitis or encephalopathy, the diagnosis can be especially difficult to make due to lack of a reliable primary historian. Case report: Here we present a case of altered mental status and new-onset bilateral lower extremity weakness in a fully vaccinated young woman diagnosed with measles infection caused by acute disseminated encephalomyelitis in the setting of vaccine failure. Conclusion: Despite a documented history of immunization, acute measles infection and its uncommon sequelae are possible. Recognizing vaccine failure and appropriately isolating patients are of paramount importance.

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