Nasal Ulceration Research Articles

Prevalence and risk factors of nasal pressure ulcers related to nasogastric intubation: an observational study

Pressure ulcers related to nasogastric tubes (NGT) are underestimated in clinical practice and rarely reported in the literature. Improper tube fixation around the nostril quickly induces tissue ischemia, possibly leading to skin ulcers and permanent full-thickness lesions. Epidemiological and clinical studies on this subject are lacking. This was an observational, cross-sectional study performed in a tertiary-care hospital. Consecutive hospital records of patients undergoing elective surgical procedures under general anesthesia, with an NGT inserted before or during surgery and maintained in place after the operation, were examined. Demographic and clinical data were extracted to investigate factors possibly associated with the occurrence of pressure ulcers of the nostril. Between 2011 and 2015, 2131 patients underwent elective surgical procedures. The overall prevalence of NGT-induced ulcers was 4.8%, with esophagectomy being the most common index operation. Univariate analysis did not show a statistically significant association between the presence of ulcers and the examined variables, with the exception of operative time (p < 0.012). The prevalence of nostril ulcers statistically differed across operative procedure time (p < 0.001), with a positive significant linear trend (p < 0.001), and lesions were significantly more frequent when the operative procedure lasted longer than 4 h (Confidence interval [CI] 9.2–17.1). Twenty-one (20.5%) patients required plastic surgery consultation due full-thickness lesions with severe cosmetic sequelae. Nostril pressure ulcers related to NGT are common in clinical practice and necessitate a high index of suspicion and vigilance during the perioperative period. The only factor significantly associated with NGT-induced pressure ulcers was the length of the operative procedure.

Efficacy Analysis of MP-AzeFlu Compared with Fluticasone Propionate Nasal Spray in Children 6 through 11 Years of Age with Allergic Rhinitis

MP-AzeFlu (Dymista®) is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) for treatment of allergic rhinitis. The objective of the current analysis was to evaluate the efficacy of MP-AzeFlu compared to FP administered 1 spray per nostril twice daily in children 6 through 11 years of age. This was a randomized, open-label, 3-month safety study in patients 4 through 11 years of age. Qualified patients had a history of AR, were in good health, and had no evidence of nasal mucosal erosion, nasal ulceration, nasal septum perforation, or any significant nasal disease. Randomization was in a 3:1 ratio (MP-AzeFlu [n=304]:FP [n=101]). Efficacy was not a pre-specified study objective but was evaluated by self-assessment of overall allergy symptom severity in a subset of patients 6 through 11 years (MP-AzeFlu [n=264]:[FP: n=89]). Symptom severity was scored on a 4-point scale from 0 to 3 (0 = none; 1 = mild; 2 = moderate; 3 = severe). Total symptom score at baseline was 1.73 in the MP-AzeFlu group and 1.80 in the FP group (max score: 3). Over the entire study period, patients treated with MP-AzeFlu experienced a -0.68 pt reduction in overall symptom score (corresponding to a -5.44 change from baseline in AM + PM reflective total nasal symptom score (rTNSS; max = 24), significantly greater relief than that afforded by FP (-0.54 pt reduction; Diff: -0.14; 95% CI: -0.28, -0.01; p=0.04). MP-AzeFlu provided significantly greater relief of AR symptoms than FP in children 6 through 11 years of age.

Use of Merocel® aids in prevention of nasal pressure ulcers following nasal intubation: Case series of 33 patients.

Use of Merocel® aids in prevention of nasal pressure ulcers following nasal intubation: Case series of 33 patients.

Risk Factors for Pressure Ulcers at the Ala of Nose in Oral Surgery.

A quality review revealed pressure ulcers at the ala of nose in 16 cases (2.2%) over 3 years. We therefore retrospectively investigated the risk factors for alar pressure ulcers from nasal tubes. Male gender was the highest risk factor (odds ratio = 9.1411; 95% confidence interval = 1.680-170.58), and the second highest risk factor was duration of anesthesia (odds ratio = 1.0048/min of anesthesia; 95% confidence interval = 1.0034-1.0065). Male gender and duration of anesthesia appear to be risk factors for nasal tube pressure ulcers at the ala of nose in patients.

Lenalidomide for refractory cutaneous manifestations of pediatric systemic lupus erythematosus.

Objective Cutaneous manifestations of pediatric systemic lupus erythematosus cause significant morbidity. Lenalidomide, a thalidomide analogue, has shown promise treating cutaneous lupus erythematosus in adults. Our objective was to evaluate lenalidomide's efficacy and safety in treating refractory cutaneous manifestations of pediatric systemic lupus erythematosus. Methods We performed a retrospective chart review of 10 adolescents who received lenalidomide for recalcitrant cutaneous lupus erythematosus. Information was gathered at drug initiation and 6-month follow-up. The Wilcoxon matched-pairs signed-rank test was used to assess change in quantitative parameters of disease activity. Results Nine subjects were girls and six were African-American. Indications for lenalidomide treatment included alopecia, nasal and oral ulcers, extensive malar rash, discoid lesions, bullous lesions, panniculitis, cutaneous vasculitis, and Raynaud's phenomenon with digital ulcerations. Within 6 months, all patients demonstrated complete or near resolution based on physician report. Prednisone dose decreased from a mean 23.5 mg (SD± 13.3) to 12.25 mg (SD± 9.2) ( P= 0.008). Sedimentation rate decreased from a mean 29 mm/hour (SD± 31.5) to 17 mm/hour (SD± 18.1) ( P= 0.004). Lenalidomide was well tolerated. Conclusion Lenalidomide is an effective and safe treatment for a spectrum of dermatological conditions in pediatric systemic lupus erythematosus. Its use may allow a reduction in prednisone dose and decreased disfigurement. Prospective study is needed to clarify lenalidomide's role in treating cutaneous manifestations of systemic lupus erythematosus.

Nasal-Type Extranodal Natural Killer/T-Cell Lymphoma Mimicking Recurrent Sinusitis: A Case Report and Review of the Literature

: Nasal-type extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is a rare type of lymphoma that is endemic to East Asia. It typically demonstrates as a destructive mass involving the midline facial tissues that causes rhinosinusitis symptoms such as nasal obstruction, sinusitis, ulcer, and epistaxis. The diagnostic tendency of nasal-type ENKTL is to use computed tomography (CT), but this may present infiltrative patterns without a prominent mass, making it difficult to distinguish ENKTL from benign inflammatory diseases. Here, we report a 59-year-old male with a chief complaint of rhinosinusitis symptoms, mimicking chronic sinusitis and a CT scan showing a typical right sinusitis pattern. Functional endoscopic sinus surgery was performed and a positive culture was consistent with the diagnosis. However, histopathological and immunohistochemical evaluation established the diagnosis of nasal type ENKTL. Follow-up positron emission tomography-computed tomography (PET-CT) also corresponded with this diagnosis, and therefore, radiotherapy and chemotherapy were indicated.

THE RATE OF CLINICAL AND BIOLOGICAL MANIFESTATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS DIAGNOSED ACCORDING TO THE CRITERIA OF THE SLICC 2012

Aims: Determine the rate of clinical and biological manifestations in Systemic Lupus Erythematosus patients diagnosed according to the criteria of The Systemic Lupus International Collaborating Clinics SLICC 2012. Patients And Method: 55 patients were diagnosed with Systemic Lupus Erythematosus according to the criteria of the SLICC 2012, treated and followed up at Department of Nephrology and Rheumatology – Hue Central Hospital from March 2014 to April 2015. Results: The clinical manifestations rate: acute cutaneous lupus 58,2%; subacute cutaneous lupus 10,9%; chronic cutaneous lupus 10,9%; oral or nasal ulcers 18,2%; nonscarring alopecia 60%; synovitis 54,5%; serositis 32,7%, neurological damage 14,6%. The biological manifestations rate: hemolytic anemia 5,5%; leukopenia &lt;4.000/mm3 25,5%; lymphopenia &lt;1.000/mm3 49,1%; thrombocytopenia &lt;100.000/mm3 16,4%; 24-hour urine protein representing &gt;500 mg protein/24 hours 69,1%; ANA positivity 96,4%; anti-dsDNA antibody positivity 89,1%. Conclusion: In this study cohort, the clinical manifestations according to the criteria of the SLICC 2012 that have the highest rate are nonscarring alopecia, followed by acute cutaneous lupus and synovitis. The other clinical manifestations with lower rate are oral or nasal ulcers, neurological damage and chronic cutaneous lupus. Regarding biological manifestations, the presence of antinuclear antibodies, anti-dsDNA antibodies and renal damage with proteinuria &gt;500mg/24 hours are the most prominent symptoms. Key words: Systemic Lupus Erythematosus, SLICC 2012

Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type Involving Skin Masquerading as Eczema

Dear Editor: Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTL) is an uncommon type of lymphoma that is endemic to East Asia and parts of Central and South America1. Most of the patients clinically present with nasal obstruction, sinusitis, ulcer, and epistaxis due to a destructive mass involving the midline facial tissues and skin is the second most commonly affected organ after nasal area1. Descriptions of cutaneous manifestations of ENKTL are of well-circumscribed lesions such as nodules/tumors, plaques and ulcers. Other atypical, various clinical morphologies have been reported including papules, cysts, ulcers, and cellulitis2. ENKTL presenting in the skin is highly aggressive with a mean survival of less than 12 months3. We report a case of extranodal NK/T-cell lymphoma, nasal type who presented with lesions clinically similar to eczema. A 63-year-old woman visited with pruritic erythematous papules and plaques with areas of postinflammatory hyperpigmentation on right upper back, left breast, and left thigh which persisted for 6 weeks (Fig. 1A~C). Under the clinical impression of eczema and urticarial dermatitis, she was treated with oral antihistamines and topical steroids ointment for 2 weeks. Despite treatment the lesions persisted and therefore skin biopsy was done on erythematous plaque of right upper back. Histopathologic findings revealed mixed atypical lymphoid cells and histiocytic cells along superficial and deep perivascular area (Fig. 2A). Lymphocytic infiltration showed perivascular pattern, with pale cytoplasm and dense chromatin with irregularly shaped nuclei (Fig. 2B). Immunohistochemical study showed CD3 and CD4 positivity in majority of lymphoid cells (Fig. 2C), focal positivity in CD8, CD30, CD56 (Fig. 2D) strong and profuse positivity in in situ hybridization for Epstein-Barr virus (EBV) (Fig. 2E). The patient was informed to visit immediately, however, did not visit within 2 weeks of notification. Five weeks after the initial visit the patient presented with left eye ptosis and swelling of left eyelid and mandibular area. Under the impression of extranodal NK/T-cell lymphoma, nasal type, the patient was transferred to hemato-oncology department. Fig. 1 Erythematous papules and plaques with areas of brownish hyperpigmentation on (A), (B) right upper back and (C) left thigh. Fig. 2 (A) Mixed atypical lymphoid cells and histiocytic cells along superficial and deep perivascular area (H&E, ×40). (B) Lymphocytic infiltration in perivascular pattern, with pale cytoplasm and dense chromatin with irregularly shaped nuclei ... The NK/T-cell lymphomas are classified into 2 subtypes, nasal and non-nasal NK/T-cell lymphomas. The non-nasal group can be further subdivided into primary cutaneous and 4 types of secondary cutaneous lymphomas: nasal-type, aggressive, blastoid, and other specific lymphoma types4,5. Nasal-type NK/T-cell lymphoma is the most common subtype among the secondary cutaneous non-nasal NK/T-cell lymphomas5. The skin is the most common extranodal site of involvement followed by the soft tissues, and could be either primary or secondary feature of the disease3. The new sites of involvement are also mostly extranodal, and are similar to the predilection sites at presentation4. Extracutaneous involvement at the time of presentation is associated with worse prognosis3. In a patient with known ENKTL, a skin biopsy should be obtained from any suspicious clinical lesion to assess for possible cutaneous involvement. Furthermore, a simple erythematous patch may be the initial presenting manifestation of the disease. In conclusion, we report a case which stresses the importance of awareness of malignancy and prompt skin biopsy in patients with erythematous papules and plaques that fail to respond to traditional management.

Cutaneous Manifestation of Systemic Lupus Erythematosus [SLE], Correlation with Specific Organ Involvement, Specific Auto Antibodies and Disease Activity and Outcome

Background: Cutaneous lesions are important as a diagnostic aid as these account for 4 out of 11 revised American Rheumatism Association criteria for disease classification Cutaneous manifestation of systemic lupus erythematosus (74.4%) and most patients had Butterfly rash (48.8%), Photosensitivity (41.9%), acute cutaneous lupus erythematosus (SCLE) (32.6%), Discoid lupus (20.9%), Nail lesions (16.3%), Alopecia (23.3%), oral nasal ulcer (37.2%), purpuric rash (23.3%), Raynaud phenomenon (16.3%), Livedo reticularis (9.3%), Telangiectasia’s (4.6%), and Urticarial lesion (2.3%). Lupus profundus (2.3%), Cutaneous manifestation of systemic lupus erythematosus are association with disease activity (97.7%), Cutaneous manifestation of systemic lupus erythematosus are association with musculoskeletal (MSK) (62.8%), Renal disease (27.9%), Hematologic disease (23.3%), Serositis (9.3%), Neurologic disease (14%),and cardiac disease (9.3%), Results: Cutaneous manifestation of systemic lupus erythematosus are association with positive ANA (90.3%) and negative ANA (9.3%), positive ds DNA (74.4%), positive Anti-Ro (69.8%), positive Anti-La (9.3%), positive Anti-SM (48.8%),and positive Anti-RNP (39.5%%). outcome of cutaneous manifestation of systemic lupus are skin atrophy and scarring (27.9%). pigmentation (25.6%) and alopecia (23.3%). Conclusion: The cutaneous lesions can provide valuable diagnosis of systemic lupus erythematosus. The most cutaneous manifestations are epidermal lesion then mucous-cutaneous lesion then vascular lesion, are associated with disease activity, and associated with high titer auto antibodies.

Extended followup of a cohort of chromium production workers.

BackgroundThe current study evaluates the mortality of 2,354 workers first employed at a Baltimore chromate production plant between 1950 and 1974.MethodsThe National Death Index (NDI Plus) was used to determine vital status and cause of death. Cumulative chromium (VI) exposure and nasal and skin irritation were evaluated as risk factors for lung cancer mortality.ResultsThere are 91,186 person‐years of observation and 217 lung cancer deaths. Cumulative chromium (VI) exposure, nasal irritation, nasal perforation, nasal ulceration, and other forms of irritation (e.g., skin irritation) were associated with lung cancer mortality.ConclusionCumulative chromium (VI) exposure was a risk factor for lung cancer death. Cancer deaths, other than lung cancer, were not significantly elevated. Irritation may be a possible mechanism for chromium (VI)‐induced lung cancer. Am. J. Ind. Med. 58:905–913, 2015. © 2015 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

Atrofični trigeminalni sindrom – klinični primer

Trigeminal trophic syndrome is a rare condition resulting from compulsive self-manipulation of the skin after a peripheral or central injury to the trigeminal system. The classic triad consists of trigeminal anesthesia, facial paresthesias, and crescentric lateral nasal alar erosion and ulceration. Although the symptoms are visibly clear, the diagnosis is not easy to establish. The appearance of the ulcers mimics many other disease entities such as neoplasm, infection, granulomatous disease, vasculitis and factitial dermatitis. Trigeminal trophic syndrome should be considered with a positive neurologic history and when laboratory and biopsy workup is inconclusive. Once diagnosis is confirmed, treatment is complicated and often multidisciplinary. We report a case of a woman who developed a strictly unilateral crescent ulcer of the ala nasi after resection of an statoacoustic neurinoma. A clinician who is faced with a patient with nasal ulceration should consider this diagnosis.

Carbamazepine as a Treatment for Trigeminal Trophic Syndrome: A Case Report and Literature Review

Trigeminal trophic syndrome (TTS) is a rare condition that results from damage to the central or peripheral branches of the trigeminal nerve. Themost common causes cited in the literature are trigeminal nerve ablation or transaction of the gasserian ganglion (as treatment of trigeminal neuralgia), stroke (specifically the Wallenberg lateral medullary syndrome), acoustic neuromas, postencephalitis, vertebrobasilar insufficiency, astrocytoma, syringobulbia, herpes zoster, and trauma. The first cases of TTS were published independently byWallenberg andLoveman in 1933. TTS is a clinical diagnosis that is characterized by paresthesia and nasal ulcerations, which are caused by repetitive scratching of the skin, in the distribution of the damaged trigeminal nerve. The time of onset varies significantly, ranging from months to decades. It is believed that patients pick or rub at the skin to relieve the irritation caused by the paresthesias, often described as a burning, itching, or crawling sensation. Decreased sensation often accompanies the paresthesias, allowing for severe disfigurement to occur with repetitive manipulation of the area. The repetitive scratching and manipulation results in painless, unilateral, crescent-shaped ulcers that classically involve the nasal ala.

The natural history of pediatric-onset discoid lupus erythematosus

Pediatric discoid lupus erythematosus (DLE) is rare. The risk of progression to systemic lupus erythematosus (SLE) is uncertain. We sought to determine the risk of progression of pediatric DLE to SLE and to characterize its phenotype. This was a retrospective review of 40 patients with DLE. Six (15%) of 40 patients presented with DLE as a manifestation of concurrent SLE. Of the remaining 34, 9 (26%) eventually met SLE criteria and 15 (44%) developed laboratory abnormalities without meeting SLE criteria. Only 10 (29%) maintained skin-limited disease. The average age at progression to SLE was 11 years, with greatest risk in the first year after DLE diagnosis. Most (89%) patients with SLE met diagnostic criteria with mucocutaneous disease (discoid lesions, malar rash, oral and nasal ulcers, photosensitivity), positive antibodies, and/or cytopenia without developing end-organ damage over 5 years of median follow-up. The study was retrospective. In pediatric patients, DLE carries a significant risk of progression to SLE but may predict a milder phenotype of systemic disease. All patients require careful monitoring for SLE, particularly within the first year of diagnosis.

Clinical Implications of the Presence of Anti-Ro Antibodies in Systemic Lupus Erythematosus in Sudan

Background: Ro- antigen is among many antigens that can be detected in SLE patients, with anti-Ro antibodies amounting to 90% in some patients. Although anti-Ro antibodies can be detected earlier than other antibodies, still their role is to be determined. Aim: To estimate the occurrence of anti-Ro antibodies in patients with SLE, and its relation to classification criteria of the American College of Rheumatology (ACR) in Sudan. Materials and Methods: Eighty- six patients with SLE, recruited from two rheumatology clinics in Omdurman- Sudan during the period November 2012 - May 2014. Participants gave consent then were interviewed for socio- demographic information and examined for skin, cardio-pulmonary, renal, neurological, and hematological manifestations to fulfill the ACR criteria for classification SLE. A Blood sample for full blood count, renal function, inflammatory markers, and antinuclear antibody profile including anti-Ro (SSA) was taken. This study was approved by the ethical committees of Omdurman and Military Teaching Hospitals. The Statistical Package for Social Sciences (SPSS) version 19 was used for data analysis. The Chi- square test was used for the relationship between categorical variables, and then Pearson's correlation was applied for different variables. Results: Mean age was 36.4±11.6years, ranged from 18- 65 years. Female dominance is obvious (94.2%). Sixty six (76.7%) of subjects had arthritis, 45(52.3%) had oral or nasal ulcers, 35(40.7%) had malar rash, 31(36%) had photosensitive rash, while discoid rash was reported in 17(19.8%). Twenty nine (33.7%) of SLE patients were positive for anti-Ro antibodies. The positive percentage was 100%, 50%, 45.8% and21.1% in patients with pericarditis, renal involvement, pleurisy and neuro-psychiatric manifestations respectively. While anti- Ro antibodies were detected in 35.9% of patients with positive anti- nuclear antibodies. Conclusion: In the present study no association was found between anti-Ro antibody and the various manifestations of SLE. Larger multicenter studies are needed to assess the occurrence of anti-Ro antibodies in SLE, and their relationship with disease activity. Keywords: Anti-Ro (SSA), SLE, ACR criteria

Primary Mucocutaneous Tuberculosis of Nose: One Decade Study

ABSTRACT Background Primary mucocutaneous tuberculosis of nose is extremely rare even in countries with high incidence of pulmonary tubercular disease. The clinicians fail to diagnose its symptoms as primary nasal tuberculosis and, therefore, its treatment is often delayed. Objective To elucidate the clinical features and discuss the diagnostic difficulties, management and outcome of primary mucocutaneous tuberculosis of nose. Materials and methods A retrospective chart review of five cases of primary mucocutaneous tuberculosis of nose was done over a period of 10 years. The clinical and imaging data, treatments, and outcomes were analyzed in these patients. Results Out of five patients of primary mucocutaneous tuberculosis of nose studied during a decade, four were females. The mean age at the time of diagnosis was 24.2 years (12–60 years). The most common presenting symptoms were progressive nasal obstruction, recurrent epistaxis, skin ulceration. All the patients had no signs of pulmonary tuberculosis. All patients had nasal endoscopic guided biopsy for the accurate diagnosis based on histopathology. Biopsy was positive in all the five cases confirming the diagnosis. All the five patients received antitubercular therapy for a period of 6 to 9 months. There was successful response to antitubercular drug treatment. The follow-up for 2 to 7 years showed no relapse, dissemination or death. Conclusion Primary nasal tuberculosis is a very rare disease. However, it is important to have a high index of suspicion for nasal tuberculosis in patients presenting with nasal obstruction, epistaxis and skin ulceration especially in countries with high prevalence of tuberculosis. How to cite this article Gupta Y, Sinha R. Primary Mucocutaneous Tuberculosis of Nose: One Decade Study. Int J Head Neck Surg 2015;6(2):69-72.

Nasal septal ulceration

Nasal septal ulceration can have multiple etiologies. Determining the exact cause depends on who the consulting specialist is, who could either be the ENT surgeon or the dermatologist. The common causes are infections (tuberculosis, leprosy, leishmaniasis), vasculitis (Wegener’s granulomatosis and Churg-Strauss syndrome), and lupus erythematosus. Traumatic causes and malignancy can also be seen in tertiary referral centers. The diagnosis often requires thorough investigations and multiple tissue specimens from various sites, and in chronic cases, a suspicion of lymphoma should be considered. Apart from disease-specific therapy, a multidisciplinary approach is required in most cases to tackle the cosmetic disfigurement.

An Unusual Case of Hematuria

A 66-year-old woman presented with acute onset of painless gross hematuria and generalized fatigue of 10 days’ duration. The patient was asymptomatic until she started to notice blood in her urine, not associated with dysuria or dribbling. Shortly afterward, she developed oliguria, and swelling of both legs, associated with mild exertional dyspnea, diffuse body aches, and fatigue without subjective fevers or chills. She had no oral or nasal ulcers, alopecia, photosensitivity, joint pain, joint swelling or redness, or symptoms of Raynaud’s phenomenon. She had mild exertional shortness of breath, but without chest pain or cough. She denied abdominal pain or any change in her bowel habits. Beside the gross hematuria, she denied any other urinary symptom. She denied weight loss, recent travels, or sick contacts. On evaluation in the emergency department, she was afebrile but hypertensive (blood pressure 188/98 mm Hg), which was a new symptom for her. She had periorbital edema as well as bilateral lower extremity pitting edema to the knees. Laboratory evaluation in the emergency room showed normocytic anemia, blood urea nitrogen of 44 mg/dl (normal range 7–18), and a creatinine level of 3.8 mg/dl (normal range 0.6–1.2). Her estimated creatinine clearance was 11.9 ml/minute/1.73 m (normal range 80–125) with a fractional excretion of sodium of 2.5%. Her creatinine was checked 3 weeks prior to admission during a routine checkup and found to be elevated at 1.4 mg/dl. She had a potassium level of 5.5 mEq/liter (normal range 3.5–5.1), a phosphorus level of 6.1 mg/dl (normal range 2.8–4.1), and a total calcium level of 8.2 mg/dl (normal range 8.4–10.2). Her urine analysis at presentation revealed 3 proteins, 3 blood, gross red blood cells (RBCs), 1–3 white blood cells, and trace leukocyte esterase. A chest radiograph performed on admission showed cardiomegaly with mild congestion. Kidney ultrasound did not show any hydronephrosis, kidney mass, or evidence of nephrolithiasis. She was admitted to the general medical floor with a diagnosis of acute kidney injury and nephrotic syndrome.

Extranodal Natural Killer/T-cell Lymphoma, Nasal Type, of the Orbit Mimicking Recurrent Orbital Cellulitis

Extranodal natural killer (NK)/T-cell lymphoma, nasal type, is a rare type of lymphoma that is endemic to East Asia and parts of Central and South America. Most patients present with nasal obstruction, sinusitis, ulcer, and epistaxis due to a destructive mass involving the midline facial tissues. The patient visited our clinic approximately 1 year ago; she had right-sided orbital swelling and pain. The patient was sent to the department of ear, nose, and throat (ENT), and computed tomographic scan was performed. Computed tomographic imaging showed a soft tissue density in the right frontal, maxillary, and ethmoidal sinus and demonstrated fungal sinusitis in the right maxillary sinus. Then, she underwent the operation at ENT; her symptoms seemed to have disappeared. After 6 months, however, she had visited our clinic again because of a left-sided orbital cellulitis that seemed to be similar to the previous right-sided symptoms 1 year ago. She received treatments immediately and the operation again at ENT. In addition, a biopsy of left ethmoid sinus tissue was performed. The biopsy result revealed "chronic inflammation." However, unfortunately, the patient had a relapse of almost the same symptoms in a month. An excisional biopsy was performed for histopathologic diagnosis again. The left ethmoid sinus biopsy results were consistent with extranodal NK/T-cell lymphoma, nasal type. The patient then transferred her care to the department of internal medicine for chemotherapy. The authors demonstrate how the progressive-staging extranodal NK/T-cell lymphoma can present in a similar fashion as a recurrent orbital cellulitis.

Concordance of nasal and diabetic foot ulcer staphylococcal colonization

Nasal carriage of Staphylococcus aureus (SA) is an important risk factor for surgical site infections. The goal of this study was to investigate the concordance between nasal and diabetic foot ulcer (DFU) SA carriage. Seventy-nine subjects with DFUs were assessed for nasal and DFU colonization with SA, including methicillin-resistant SA (MRSA). Twenty-five (31.6%) subjects had nares colonization with SA; 29 (36.7%) had DFU colonization with SA. Seven (8.8%) subjects had nares colonization with MRSA, and 7 (8.8%) had DFU colonization with MRSA. Ulcer duration was associated with MRSA presence (P = 0.01). Sensitivity and specificity of positive nasal SA colonization with positive DFU colonization were 41% and 74%. We found substantial discordance between SA strains colonizing DFU and the nasal cavity. The poor positive predictive values for SA isolation in a DFU based on nasal carriage suggests that SA colonization of a DFU by endogenous SA strains cannot be assumed.

Nasal mucosa ulceration and septal perforation as initial presentation of a patient with probable Behcet's disease

Behcet's disease is a vasculitis that affects multiple systems in the body, classically oral and genital mucosa. Nasal mucosa involvement is a rare manifestation of the disease, reported in only a handful of patients. We present an HLA-B51 positive, suspected Behcet's patient with predominantly nasal manifestations including epistaxis, nasal mucosa ulceration and septal perforation. Her nasal symptoms have improved since being started on a daily regimen of colchicine. We believe this case supports the wide clinical heterogeneity of the disorder, and serves as a reminder to consider Behcet's disease when a patient presents with an atypical head and neck manifestation.