Toothache, Paresthesia, and Horner Syndrome: An Unusual Presentation of Disseminated Burkitt’s Lymphoma

Abstract

the telogen phase, with resultant loss of hair months later. This is an example of delayed anagen release. Examples of immediate anagen release are multiple. Major surgery, febrile illnesses, infections, trauma, chronic illness (such as systemic lupus erythematosus and malignancy), crash dieting, and medications such as heparin, beta-blockers, and retinoids may cause early transformation of hair follicles to the telogen phase. Clinically, patients with telogen effluvium may claim that their hair is falling out and they may even bring bags of shed hair to demonstrate the quantity of the loss. Patients are emotionally distraught and assume that they are going bald. The hair loss is diffuse and there is often a positive pull test. A history should be obtained, including an investigation for possible triggering events. A triggering event, which occurs 1 to 3 months earlier, cannot be identified in 30% of cases. The treatment of acute telogen effluvium involves constant patient reassurance with resolution of hair loss, usually within 6 months of the diagnosis. Chronic telogen effluvium lasts greater than 6 months. There are no medications that have been shown to shorten the clinical course. The patient in the above case exhibited many of these findings and her hair loss resolved within 2 months. The orthognathic surgery patient is at risk for telogen effluvium because he/she is subject to many physiologic and psychologic stressors. The stress of a major surgery,