Abstract
Pathologie Quiz Case 1 Steve Hunyadi, Jr, MD, Anthony J. Maniglia, MD, Cleveland, Ohio A 22-Year-Oldpreviously healthy white man presented with a 4-month history of an 18-kg weight loss, facial and temporal pain, trismus, bilateral otalgia, fullness and otorrhea, fever, malaise, abdominal pain, generalized weakness and pain, nausea, vomiting, and intermittent night sweats and chills. He also described a progressive decrease in his hearing bilaterally over the past 4 months. The patient had previously been diagnosed with sinusitis and bilateral otitis media (OM) that was refractory to antibiotic therapy. Previous evaluation of the patient at another hospital included chest roentgenograms and a computed tomographic scan of the chest that revealed multiple pulmonary nodules. A computed tomographic scan of the head revealed mucosal thickening in the ethmoid and sphenoid sinuses and bilateral OM. Magnetic resonance imaging of the head revealed a possible bilateral mastoiditis. Biopsy specimens of a nasal polyp and medial pterygoid muscle, as well as an aspirate of a right pulmonary
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