Granulomatosis with polyangiitis as a differential diagnosis.

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Anna Luiza De Araujo Neurauter ◽  
Noemí Andrade Albán
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Acute Otitis Media ◽  
Rare Condition ◽  
Pulse Therapy ◽  
Upper Respiratory Tract ◽  
Conjunctival Hyperemia ◽  
Small Vessels ◽  
Recurrent Acute Otitis Media ◽  
Clinical Stability

Granulomatosis with polyangiitis, a small vessels vasculitis, involves mostly upper respiratory tract, lungs and kidneys. It’s a multisystemic pathology, with no sex predominance, affecting adults over 40 years old. Case report: K.S.D, 64 years, female, came to emergency room with dyspnea, cough and coryza, 15 days after a recurrent acute otitis media surgical treatment. A CT showed bilateral pleural effusion, consolidation and a lung mass, being admitted in Intensive Care Unit. Subsequently, developed mastoiditis and conjunctival hyperemia and used several antibiotic therapys. Patient was discharged 40 days later, with clinical improvement. One month later, was admitted again with pulmonary septic shock, in addition to sinusitis, polyarthralgia, purpura and acute renal injury, requiring hemodyalisis. Biomarkers were requested, such as c-ANCA and rheumatoid factor, with positive result and antinuclear factor, with negative result. A renal biopsy also has been solicitated, showing glomerulonephritis. The diagnosis was granulomatosis with polyangiitis, treated with methylprednisone pulse therapy and cyclophosphamide, progressing to clinical stability and receiving discharge with outpatient follow-up. Conclusion: Granulomatosis with polyangiitis is a rare condition, with that should be considered when patient presents the triad: upper and lower airways and glomerulonephritis. Early diagnosis and immunosuppressive therapy are essential to reduce its morbimortality. Recibido: 18-11-2017 / Aceptado: 25-01-2018

scholarly journals Acute otitis media in an infant complicated with osteoarthritis of temporomandibular joint and sub-periosteal abscess of the clavicle

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Kaoutar Cherrabi ◽  
Hind Cherrabi
Keyword(s):  
Septic Arthritis ◽  
Temporomandibular Joint ◽  
Nutritional Assessment ◽  
Acute Otitis Media ◽  
Clinical Signs ◽  
Rare Condition ◽  
Pediatric Emergency ◽  
Ear Infections ◽  
The Right

Abstract Background Otomastoiditis is a very frequent affection and a current complication of mal-treated benign ear infections in children. However, this a very rare case of the association of two rare complications of otomastoiditis in a newborn. On the one hand, septic arthritis of the temporomandibular joint which is a very rare condition that is difficult to diagnose, and when unrecognized or not treated accordingly, it can resolve in serious infectious complication and or definitive injury to the temporomandibular joint. On the other hand, osteomyelitis of the clavicle is also very rare, and only a few cases have been cited in the literature concerning infants. Case presentation This 46-day-old infant was brought to pediatric emergency consultation for 2 swelling inflammatory bulges, one in the right mastoid and pre-auricular regions, and another in the right basi-cervical area. The infant was hypertrophic febrile, hypotonic, and pale. He had preserved archaic reflexes. Besides, blood test showed an inflammatory syndrome, inflammatory anemia, and no other abnormalities. Upon supplementary computed tomodensitometry exam, the diagnosis of a combination of septic arthritis of the right temporomandibular joint and sub-periosteal abscess of the ipsilateral clavicle in a context of hypotrophy and malnutrition was suspected. A pus sample was obtained for bacteriological evaluation, after which the infant had a course of intravenous associated antibiotics, along with nutritional assessment and management. Surgical drainage of both collections was performed. The 6-month follow-up was satisfactory, without clinical signs of functional impact on temporomandibular joint, or acromioclavicular joint. Conclusion This work stresses the necessity of thorough clinical examination of infants even in cases of benign ear infections, as well as the importance of adapted treatment and follow-up, which could allow early diagnosis, appropriate treatment, or even prevention of severe complications that can be associated with such benign conditions.

scholarly journals Comparative study of once-weekly azithromycin and once-daily amoxicillin treatments in prevention of recurrent acute otitis media in children.

1996 ◽  
Vol 40 (12) ◽  
pp. 2732-2736 ◽  
Author(s):  
P Marchisio ◽  
N Principi ◽  
E Sala ◽  
L Lanzoni ◽  
S Sorella ◽  
...  
Keyword(s):  
Otitis Media ◽  
Randomized Study ◽  
Acute Otitis Media ◽  
Occurrence Rate ◽  
Once Daily ◽  
Recurrent Acute Otitis Media ◽  
Periodic Administration ◽  
Resistant Strains ◽  
Selection Of

Continuous chemoprophylaxis is effective in the prevention of new episodes of acute otitis media (AOM) in otitis-prone children, but compliance can be a problem and thus efficacy can be decreased. Intermittent chemoprophylaxis has so far shown conflicting results. Azithromycin, which has a peculiar pharmacokinetics, resulting, even after a single dose, in persistently elevated concentrations in respiratory tissues, could permit a periodic administration with higher compliance. We compared a 6-month course of once-weekly azithromycin (5 or 10 mg/kg of body weight) with that of once-daily amoxicillin (20 mg/kg) in a single-blind, randomized study of prophylaxis for recurrent AOM in 159 children aged 6 months to 5 years with at least three episodes of AOM in the preceding 6 months. In the amoxicillin group, 23 (31.1%) of 74 children developed 29 episodes of AOM, while in the 10-mg/kg azithromycin group, 11 (14.9%) of 74 children experienced 15 episodes. The 5-mg/kg/week azithromycin trial was prematurely interrupted after nine cases, due to the high occurrence rate of AOM (55.5%). During the 6-month prophylaxis period, the proportion of children with middle ear effusion declined similarly in both groups. No substantial modification of the nasopharyngeal flora was noted at the end of prophylaxis in both antimicrobial groups. In the 6-month-postprophylaxis follow-up period, about 40% of children in both groups again developed AOM. Azithromycin at 10 mg/kg once weekly can be regarded as a valid alternative to once-daily low-dose amoxicillin for the prophylaxis of AOM. Although in the present study no microbiological drawback was noted, accurate selection of children eligible for prophylaxis is mandatory to avoid the risk of emergence of resistant strains.

Effect of Insurance Type on Postoperative Tympanostomy Tube Follow-up

2021 ◽  
pp. 019459982110675
Author(s):  
Terral A. Patel ◽  
Jennifer L. McCoy ◽  
Michael A. Belsky ◽  
Edward S. Sim ◽  
Anisha Konanur ◽  
...  
Keyword(s):  
Otitis Media ◽  
Odds Ratio ◽  
Private Insurance ◽  
Tertiary Care ◽  
Acute Otitis Media ◽  
Common Procedure ◽  
Insurance Type ◽  
Recurrent Acute Otitis Media ◽  
Ed Visits

Objective Bilateral myringotomy with tube insertion (BMT) is a common procedure performed in children. Appropriate follow-up is necessary to ensure management of postoperative sequalae. The objectives are to investigate (1) the relationship between insurance type and postoperative follow-up attendance and (2) the effect of follow-up on need for further care after BMT. Study Design Retrospective cohort study. Setting The study included patients <3 years of age undergoing BMT for recurrent acute otitis media at a tertiary care children’s hospital within a single year and followed for 3 years. Patients were excluded if they had received a prior BMT; underwent a concurrent otolaryngologic procedure; or had a syndromic diagnosis, craniofacial abnormality, or any significant cardiac or respiratory comorbidity. Methods Number of follow-up appointments, demographics, socioeconomic status, and postoperative outcomes were analyzed. Results A total of 734 patients were included with mean (SD) age of 1.4 years (0.50). The majority of patients had private insurance (520/734, 70.8%). Patients with public insurance attended fewer postoperative appointments (1.5 vs 1.8, P < .001) and had a higher incidence of BMT-related emergency department (ED) visits (10.3% vs 3.8%, P = .001). There was no significance found when different insurance providers were compared. An adjusted multivariate regression analysis showed that patients with private insurance were more likely to attend postoperative appointments (odds ratio, 3.52 [95% CI, 2.12-5.82]; P < .001) and less likely to have a BMT-related ED visit (odds ratio, 0.42 [95% CI, 0.20-0.89]; P = .024). Conclusion Insurance type is related to outcomes after the treatment of recurrent acute otitis media with BMT. Future studies that survey individuals will help identify barriers that contribute to patient absence at follow-ups and need for subsequent ED visits.

Language development in children with recurrent acute otitis media during the first three years of life. follow-up study from birth to seven years of age

1993 ◽  
Vol 107 (5) ◽  
pp. 407-412 ◽  
Author(s):  
Göran Harsten ◽  
Ulrika Nettelbladt ◽  
Lucyna Schalén ◽  
Olof Kalm ◽  
Karin Prellner
Keyword(s):  
Language Development ◽  
Otitis Media ◽  
Early Onset ◽  
Acute Otitis Media ◽  
Study Groups ◽  
Healthy Children ◽  
Follow Up Study ◽  
Recurrent Acute Otitis Media ◽  
Linguistic Analyses

From a cohort of 113 children, followed prospectively from birth during the first three years of life regarding different aspects of acute otitis media (AOM), two study groups were selected for the present investigation: 13 children with recurrent AOM (rAOM, i.e. at least six episodes of AOM during a 12–month period), and 29 children without any AOM episode. The purpose of this study was to analyse the possible effects of early onset rAOM on language development as assessed at four and seven years of age at phoniatric and linguistic examinations performed blindly. There were no differences between the two groups on any of the linguistic analyses performed, although the rAOM group manifested a somewhat better performance on auditory discrimination tests at four years of age. The results of the present study show that rAOM during the first three years of life, in otherwise healthy children, does not cause a detectable delay of language development at four and seven years of age.

Eosinophilic angiocentric fibrosis of the nose and sinuses

2014 ◽  
Vol 128 (12) ◽  
pp. 1071-1077 ◽  
Author(s):  
J Rimmer ◽  
P Andrews ◽  
V J Lund
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Case Series ◽  
Rare Condition ◽  
Surgical Excision ◽  
Upper Respiratory Tract ◽  
Immunoglobulin G4 ◽  
Disease Spectrum ◽  
Complete Surgical Excision ◽  
Male Patients ◽  
Eosinophilic Angiocentric Fibrosis

AbstractBackground:Eosinophilic angiocentric fibrosis is a rare benign disorder of the upper respiratory tract. It is slow growing and progressive, with characteristic histological appearances.Methods:We report the largest single-institution case series of sinonasal eosinophilic angiocentric fibrosis to date, comprising nine patients. The current literature is reviewed, showing emerging evidence that this condition may belong to the immunoglobulin G4-related disease spectrum.Results:The series comprised five female and four male patients, with a mean age at presentation of 53 years. All were treated surgically. Six patients had no signs of recurrent disease after an average of 8.5 years. One patient went on to develop granulomatosis with polyangiitis (Wegener's granulomatosis), which required immunosuppressive therapy.Conclusion:The first-line management of this rare condition is complete surgical excision. Chronic granulomatous conditions, including granulomatosis with polyangiitis, should be excluded before a diagnosis is made, and patients should be carefully followed.

Granulomatosis with Polyangiitis (Wegener's Granulomatosis): Evolving Concepts in Treatment

2018 ◽  
Vol 39 (04) ◽  
pp. 434-458 ◽  
Author(s):  
Ariis Derhovanessian ◽  
Henry Tazelaar ◽  
John Belperio ◽  
Joseph Lynch
Keyword(s):  
Respiratory Tract ◽  
Wegener’S Granulomatosis ◽  
Granulomatosis With Polyangiitis ◽  
Treatment Strategies ◽  
Granulomatous Inflammation ◽  
Wegener's Granulomatosis ◽  
Upper Respiratory Tract ◽  
Small Vessels ◽  
Successful Induction ◽  
Indolent Disease

AbstractGranulomatosis with polyangiitis (GPA), formerly termed Wegener's granulomatosis, is the most common of the pulmonary vasculitides. GPA typically involves the upper respiratory tract, lower respiratory tract (bronchi and lung), and kidney, with varying degrees of disseminated vasculitis. Cardinal histologic features include a necrotizing vasculitis involving small vessels, extensive “geographic” necrosis, and granulomatous inflammation. The spectrum and severity of the disease is heterogeneous, ranging from indolent disease involving only one site to fulminant, multiorgan vasculitis. Circulating antibodies against cytoplasmic components of neutrophils (ANCAs) play a role in the pathogenesis, and often correlate with activity of the disease. Treatment strategies are evolving. Cyclophosphamide (CYC) plus corticosteroids was the mainstay of therapy for generalized, multisystemic GPA since the 1970s. However, within the past decade, rituximab (RTX), a monoclonal antibody directed against B cells, has been shown to be at least as effective (and possibly more effective) as CYC. Furthermore, the use of RTX may reduce the need for maintenance immunosuppression. Optimal therapy for GPA remains controversial, and additional studies are required to determine the role and duration of maintenance therapy following successful induction therapy.

A Case of Generalized Wegener's Granulomatosis in Childhood: Successful Therapy With Cyclophosphamide

PEDIATRICS ◽  
1978 ◽  
Vol 61 (2) ◽  
pp. 286-290
Author(s):  
Radhakrishna Baliga ◽  
Chung-Ho Chang ◽  
Anil K. Bidani ◽  
Eugene V. D. Perrin ◽  
Larry E. Fleischmann
Keyword(s):  
Wegener’S Granulomatosis ◽  
Renal Involvement ◽  
Rare Condition ◽  
Wegener's Granulomatosis ◽  
Cytotoxic Agents ◽  
Upper Respiratory Tract ◽  
Pediatric Age Group ◽  
Upper Respiratory ◽  
Tract Infections

An 11-year-old white boy had Wegener's granulomatosis, a rare condition in the pediatric age group. The clinical course, pathological findings, and mode of treatment are outlined. The disease is in remission on a regimen of cyclophosphamide therapy as judged by both clinical and pathological criteria. This syndrome with protean manifestations should be considered in children with symptoms of repeated upper respiratory tract infections along with pulmonary and renal involvement. Early renal biopsy helps to establish the diagnosis of generalized involvement and to guide the course of treatment. Follow-up renal biopsies may serve as an indication for the continuation of treatment. Cytotoxic agents, especially cyclophosphamide, dramatically alter the course of the disease.

scholarly journals Incidental Lowering of Otitis-media Complaints in Otitis-prone Children During COVID-19 Pandemic: Not All Evil Comes to Hurt

2020 ◽  
Author(s):  
Sara Torretta ◽  
Pasquale Capaccio ◽  
Ilaria Coro ◽  
Samantha Bosis ◽  
Elisabetta Pace ◽  
...  
Keyword(s):  
Otitis Media ◽  
Acute Otitis Media ◽  
Upper Respiratory Tract ◽  
Global Improvement ◽  
Negative Finding ◽  
The Mean ◽  
Upper Respiratory ◽  
Tract Infections ◽  
Positive Effect

Abstract Given COVID-19 pandemic periodic outpatient assessment of otitis-prone children regularly followed at our tertiary outpatient clinic of upper respiratory tract infections was discontinued since March 9th. In order to avoid leaving the patients to themselves just during the winter months which are the most critical ones for these children, we kept in touch with the families of 102 children (mean age 41.4±14.0 months) who had had a follow-up visit scheduled during the lockdown, and compensated with telemedicine assessment. This incidentally lead to the unexpected but not at all negative finding that a consistent clinical improvement had been occurred in most (82.3%) of children. A statistically significant reduction in the mean number of documented acute otitis media episodes, otorrhea episodes, and systemic antibiotic treatments during the February-April 2020 period compared to February-April 2019 was attested. Clinical evaluation performed in 27.4% cases revealed normal middle ear findings in all but three (89.3%) children.Conclusion: Our data document a global improvement of otitis-prone children in Milan during the Italian lockdown, as a fortuitous and incidental positive effect of the national lockdown.

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