Recurrent Painful Swelling Research Articles

Talus osteomyelitis by Candida krusei with multiple huge cystic lesions: a case report and review of literatures

BackgroundOsteomyelitis due to Candida krusei are extremely rare, given that only six cases have been reported, all of which are limited to the patients with immunocompromising risk factors. Here we report a case of C. krusei osteomyelitis in an immunocompetent patient, presenting with multiple huge cystic lesions of talus.Case presentationA 66-year-old female presented with one year history of painful swelling of right ankle and a draining sinus around lateral malleolus. Five months and three months ago, she had undergone arthroscopic synovectomy and bursectomy which revealed no causative organism. Open bursectomy with sinus tract excision was performed and intravenous antibiotic was administered. Two year after the surgery, the patient revisited the clinic for recurrent painful swelling with pus drainage at the same location. Multiple huge cystic lesions with osteolysis and sclerotic rim of talus were found and C. krusei was isolated from tissue culture. The patient received surgical debridement and prolonged antifungal treatment comprising caspofungin and voriconazole.ConclusionsIn this case, C. krusei infection showed atypically aggressive osteolysis shown as multiple huge cystic abscess. High index of suspicion is critical for early diagnosis and treatment to prevent such devastating results even in an immunocompetent patient.

A large submandibular salivary stone: A case report

Sialolithiasis accounts for the most cases of salivary gland obstruction which leads to recurrent painful swelling of the involved gland which often exacerbates while eating. Stones may be encountered in any of the salivary glands but most frequently in the submandibular gland and its duct. This is a case report of a 40-year-old male patient who had a submandibular sialolith. The sialolith was removed with intraoral approach and no post-operative complications were noted. The article also reviews the various available diagnostic modalities and treatment options.

Chronic Osteomyelitis of the Jaw: Pivotal Role of Microbiological Investigation and Multidisciplinary Management—A Case Report

A 15-year-old girl with a history of recurrent painful orofacial swelling was diagnosed on the basis of clinical findings, histopathological examination and imaging modalities as having primary chronic osteomyelitis of the jaw. Initial microbiological samples were performed but were inconclusive. She received multiple empirical antibiotic therapies and NSAIDs for 3 years without complete remission. Only MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization–Time Of Flight) analysis after additional multiple microbiological bone samples with adequate techniques yielded the final diagnosis of bacterial chronic osteomyelitis of the jaw. Its management requires a multidisciplinary approach, involving oral and maxillofacial surgeons, infectiologists and microbiologists, to limit treatment failure. Antibiotic therapy without surgery for 6 months achieved the complete radiographic resolution of the CBCT (Cone Beam Computed Tomography) and the normalization of laboratory tests. After 2 years of follow-up, no relapse had been reported. Modern microbiological investigation and sampling techniques are critical for the accurate diagnosis and management of osteomyelitis of the jaw, especially in unusual and clinically misleading forms of this infection.

A case report on the management of Riju bhagandara (low anal trans-sphincteric fistula) by modified conventional Ksharasutra therapy

Bhagandara (~anal fistula) is a challenging surgical condition due to its high recurrence rate and anal incontinence. Acharya sushruta has explained surgical and para-surgical techniques for its management. Ksharasutra therapy is a time-tested para-surgical modality for Bhagandara with least recurrence (3.33%). Modified conventional technique of application of Ksharasutra is aimed to eliminate infected source and facilitate healing in short duration. A 30-year-old male patient presented with recurrent painful swelling with intermittent pus discharge from the base of the scrotum for one and half years. He underwent incision and drainage twice in the last six months. Magnetic resonance imaging revealed an anterior fistulous tract representing as St. James Type 1 Fistula, which varied from clinical features. He was treated with Modified Conventional Kshara Sutra Therapy (MC-KST) and whole length of fistulous tract was healed completely within five weeks. Anal fistula with scrotal extension is considered a complex manifestation to manage. In MC-KST method, tract was intercepted nearer to sphincter and infected crypto-glandular lesion was eradicated by Ksharasutra. The study concluded that MC-KST is one option to manage anal fistula with scrotal extension to preserve normal perineal structures.

Recurrent Myxoid Chondrosarcoma of Mandible: A Case Report

Myxoid chondrosarcoma is a rare malignant neoplasm of bone or soft tissue origin, characterised by the presence of chondroid and myxoid matrix. These are traditionally radio resistant tumours, so wide surgical resection remains the mainstay of treatment. However, radiotherapy is generally advised for high-grade lesions with poor prognostic factors with adjuvant chemotherapy. The treatment decisions are primarily guided by the histological grade, extent of surgical resection, and site of the neoplasm. A case of a 28-year-old male who presented with recurrent painful swelling in the mandibular region is discussed here. To date, very few cases of Extraskeletal Myxoid Chondrosarcoma (EMC) occurring in the mandible region have been reported. So, due to the paucity of available literature, controversies still exist regarding effective treatment approaches in newly diagnosed and recurrent cases. This case reports the clinical presentation, histopathology, radiological characteristics, immune profile, and treatment modalities used in EMC with a comprehensive and relevant review of the literature.

Neutrophil Extracellular Traps Promote the Development and Growth of Human Salivary Stones.

Salivary gland stones, or sialoliths, are the most common cause of the obstruction of salivary glands. The mechanism behind the formation of sialoliths has been elusive. Symptomatic sialolithiasis has a prevalence of 0.45% in the general population, is characterized by recurrent painful periprandial swelling of the affected gland, and often results in sialadenitis with the need for surgical intervention. Here, we show by the use of immunohistochemistry, immunofluorescence, computed tomography (CT) scans and reconstructions, special dye techniques, bacterial genotyping, and enzyme activity analyses that neutrophil extracellular traps (NETs) initiate the formation and growth of sialoliths in humans. The deposition of neutrophil granulocyte extracellular DNA around small crystals results in the dense aggregation of the latter, and the subsequent mineralization creates alternating layers of dense mineral, which are predominantly calcium salt deposits and DNA. The further agglomeration and appositional growth of these structures promotes the development of macroscopic sialoliths that finally occlude the efferent ducts of the salivary glands, causing clinical symptoms and salivary gland dysfunction. These findings provide an entirely novel insight into the mechanism of sialolithogenesis, in which an immune system-mediated response essentially participates in the physicochemical process of concrement formation and growth.

Cysticercosis of Masseter Muscle: A Diagnostic Dilemma

The masseter muscle cysticercosis is a rare soft tissue entity. Among so many causes of swelling of face this entity is very rare and making diagnosis difficult. Infestation of larvae of Taenia solium (tapeworm) causes cysticercosis in humans. Here, we have reported a case of cysticecosis inside masseter muscle, presenting with recurrent painful swelling of face. Diagnosis was confirmed after high resolution ultrasonography (HRUSG) and magnetic resonance imaging (MRI) and it was managed conservatively. How to cite this article: Ram H, Kumar S, Atam I, Sonkar SK, Bharti H, Mohammad S. Cysticercosis of Masseter Muscle: A Diagnostic Dilemma. J Adv Res Med 2019; 6(4): 16-19. DOI: https://doi.org/10.24321/2349.7181.201920

Sclerotherapy treatment of an assumed aneurysmal bone cyst in a dog

A 3-month-old, 18 kg, female St Bernard breed dog was presented with recurrent left forelimb lameness and painful swelling of the antebrachium. A large expansile lytic lesion within the left...

Pediatric sialendoscopy indications and outcomes

Chronic sialadenitis can affect patients of all age ranges and typically presents as recurrent or chronic painful swelling of the salivary glands. In children, the most common cause of sialadenitis is juvenile recurrent parotitis. Salivary stones, or sialolithiasis, are a much less common cause. Historically, for patients with chronic sialadenitis who failed conservative management, salivary gland removal was the standard treatment option. Recently, however, sialendoscopy has emerged as an effective gland-preserving procedure for sialadenitis evaluation and treatment in adults and children. The aim of this review is to discuss pediatric sialadenitis evaluation and treatment, including sialendoscopy indications, technique, and outcomes. Sialendoscopy is a well tolerated and effective treatment for sialadenitis Sialendoscopy and salivary duct irrigation have been shown to improve frequency and severity of sialadenitis episodes in patients with juvenile recurrent parotitis. Salivary stones are managed successfully with endoscopic and combined endoscopic-assisted open approaches. Minimally invasive approaches with sialendoscopy have improved the ability to preserve salivary glands in patients with recurrent sialadenitis. Sialendoscopy is a well tolerated and effective procedure for recurrent sialadenitis in children.

Multiple parotid calculi: a rare case presentation

Abstract The aim of this study was to present a rare case of multiple parotid calculi (intraglandular and intraductal). Here, we report the case of a 35-year-old man presenting with recurrent painful swelling over the left parotid region. Total conservative parotidectomy was performed. The patient was completely symptom free postoperatively and there was no complication. Management of multiple intraparenchymal and intraductal parotid calculi is not straightforward. Parotidectomy may be required in some selected cases.

Fistular Opening below the Intertragric Notch: A Rare Variant of Pre-Auricular Sinus.

A 22-year-old female presented in the Department of Otorhinolaryngology, Institute of Medical Sciences, BHU, Varanasi with complaints of recurrent painful swelling, itching and discharge from left postauricular area for ten years, for which she was operated five year back and the swelling was excised. But her symptoms persisted after surgery. She had history of incision and drainage twice in the left ear after that. On careful examination a sinus opening was found just below the intertragic notch since birth. Scar mark of previous incision and scarring present in postauricular area [Table/Fig-1a,b]. During the surgery, local anaesthesia was given around sinus opening located below intertragic notch and in retroauricular area. Methylene blue dye was injected in the sinus tract. An elliptical incision was made around sinus tract and in retroauricular area and the sinus tract was dissected from surrounding structure under visual guidance. On tracing the sinus tract, the sinus tract was seen to be passing through the conchal cartilage [Table/Fig-2a,b]. Hence, a piece of conchal cartilage was excised along with the tract and the sample was sent for histopathological examination. The sinus tract was not related to parotid tissue and facial nerve. Histopathology confirmed that the excised tissue was a sinus tract lined with squamous epithelium [Table/Fig-3]. The patient was followed up for six months and no any further complains were reported.

Treatment of juvenile recurrent parotitis of childhood: an analysis of effectiveness.

Juvenile recurrent parotitis (JRP) is characterized by recurrent painful swelling of the parotid gland that occurs in the pediatric population. Sialendoscopy with and without ductal corticosteroid infusion (DCI) has been found to be effective in the treatment of JRP and autoimmune parotitis. To determine the utility of instrumentation vs pharmacotherapy alone for juvenile recurrent parotitis. A retrospective medical record review of pediatric patients undergoing DCI without sialendoscopy at a tertiary pediatric hospital was conducted. The medical records were reviewed to determine the frequency of parotitis events before and after treatment. A multiquestion telephone survey of patients and their parents who underwent the procedure was then conducted to determine patient satisfaction. Ductal corticosteroid infusion with hydrocortisone through catheter inserted in the parotid duct. Frequency of symptoms before and after treatment and parental satisfaction with the treatment. Twelve patients with a mean age of 6.7 years were identified. The mean duration and frequency of symptoms before the procedure were 22 months and every 2 months, respectively. Five patients had a recurrence, on average 4 months after the procedure. Four patients underwent repeated surgical procedures. All had a longer duration between episodes compared with before DCI. Eight parents participated in the survey on satisfaction with the procedure, and 75% reported improvement in their child's life postprocedure. Current literature shows sialendoscopy with corticosteroid application is successful in treating JRP, but it is unclear whether corticosteroid application alone would treat JRP equally. This study shows that DCI alone has similar results as sialendoscopy with corticosteroid application, indicating that it is the corticosteroid application and not the sialendoscopy causing improvement in symptoms. Because JRP must be differentiated from sialolithiasis, we recommend ultrasonography of the involved parotid(s) prior to using DCI alone to ensure no stone is present. Sialendoscopy should be reserved to rule out other parotid ductal pathologic conditions.

English

Sialoliths are calcified structures that develop within the ductal system and is the most common disease affecting the salivary glands which lead to recurrent painful swelling of the involved gland which often increases while eating. Submandibular salivary gland is the commonest site. Their findings are usually incidental until an acute phase is encountered. Here we present a case report of a 56 year old man who presented with pain and swelling in the lower jaw.

A new missense mutation in FGF23 gene in a male with hyperostosis–hyperphosphatemia syndrome (HHS)

Hyperostosis-hyperphosphataemia syndrome (HHS) is a rare autosomal recessive metabolic disorder, characterized by recurrent painful swelling of long bones, periosteal new bone formation and cortical hyperostosis or intramedullary sclerosis, hyperphosphatemia and low intact fibroblast growth factor 23 (FGF23) protein levels. It is caused by mutations in 2 genes, N-acetylgalactosaminyltransferase 3 (GalNAc-transferase; GALNT3) and FGF23. We have performed mutation analysis of the GALNT3 and FGF23 genes in a patient with HHS and detected a homozygous mutation in exon 3 of FGF23 gene (NM_020638.2: c.471C>A) which results in amino acid change from phenylalanine 157 to leucin (p.F157L) in receptor interaction site.

Fallbericht einer granulomatös-nekrotisierenden Sialadenitis

This article presents the case of a 43-year-old male patient with recurrent painful swelling of the right submandibular gland. Submandibulectomy was performed. Histological investigations showed an intense granulomatous inflammation with severe destruction of the parenchyma. The inflammatory infiltrate consisted of abscesses with neutrophilic and eosinophilic granulocytes and ill-defined granulomas with multinucleated giant cells. Some of the blood vessels showed evidence of vasculitis. After further clinical and serological investigations with highly elevated levels of cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) and antiproteinase-3 antibodies, a rare limited disease of granulomatous polyangiitis (Wegener granulomatosis) was finally diagnosed. Such a manifestation of the disease is exceedingly rare; therefore, only single case reports have so far been described. The certain establishment of the diagnosis seems to be challenging because of the lack of involvement of the respiratory tract and the kidneys. In this case a histological assessment and clinical findings are mandatory for the correct diagnosis.

Multiple bilateral submandibular gland sialolithiasis

Sialolithiasis accounts for the most common etiology of salivary gland obstruction which leads to recurrent painful swelling of the involved gland which often exacerbates while eating. Stones may be encountered in any of the salivary glands but most frequently in the submandibular gland and its duct. Simultaneous sialolithiasis in more than one salivary gland is rare, occurring in fewer than 3% of cases. Seventy to 80% of cases feature solitary stones; only about 5% of patients have three or more stones, the case report which we are presenting here had three submandibular sialoliths involving both the submandibular glands which were removed by intraoral approach and no post-operative complications were noted.

Submandibular gland sialolithiasis with chronic sialadenitis: A case report

The most common non-neoplastic salivary gland disease is obstructive sialadenitis. Sialoliths are the main cause of obstructive submandibular sialadenitis. Sialolithiasis leads to recurrent painful swelling of the involved gland, which increases in size during meals. Sialoliths occurs commonly in the submandibular gland in 80% of the cases. Pathogenesis of sialolithiasis seems to be based on anatomical position of the salivary duct and gland. This article reports a case of submandibular gland sialolithiasis with chronic sialadenitis of the right side in 55-year-old male patient with recurrent symptoms of pain and swelling during mealtime. Clinical and radiographic fi ndings are important in determining the precise location and size of the sialolith. It helps in establishing the right treatment for the individual patient. Diagnosis of sialolithiasis is based on careful consideration of patient history and thorough clinical examination which demonstrates its typical symptoms.

A case of vitiligo associated with paraffin injection.

Dear Editor: Vitiligo is an acquired depigmentation disorder characterized by a progressive loss of melanocytes. The exact pathologic mechanism has not been clarified yet; however, the autoimmune hypothesis is the most widely accepted explanation. In some case reports, vitiligo was induced by trauma such as tattooing, eyebrow plucking, and intense pulse light treatment1,2,3. A 51-year-old woman presented with a 5-month history of multiple depigmented patches on both hands and the right foot. Importantly, she had received a paraffin injection on the dorsum of both hands, which had been performed by an unlicensed person 2 years ago. This was complicated by foreign body reaction accompanied by painful swelling of the injection sites, 1 month after the procedure. She had undergone partial removal of the granulomatous lesions and had been treated with oral corticoste intermittently for episodes of recurrent painful swelling. Five months ago, she began to notice numerous depigmented patches on both hands, including the paraffin injection sites, which were followed by new depigmented patches on the dorsum of the right foot, a month later. There was no personal or family history of vitiligo. Physical examination revealed multiple well-demarcated depigmented patches on the dorsum of both hands and on the dorsum of the right foot (Fig. 1A, B). Histopathological examination of the lesion showed aggregations of multiple clear vacuoles and lipophages in deep dermis (Fig. 2A, B). Additionally, Fontana-Masson and Melan-A staining demonstrated the loss of melanin pigments and melanocytes (Fig. 2C, D). Given the patient's history, clinical characteristics, and histopathologic findings, we diagnosed this case as vitiligo associated with paraffin injection. Fig. 1 Multiple well-demarcated depigmented patches on the dorsum of both hands (A) and of the right foot (B). Fig. 2 Biopsy specimen from the dorsum of the hand. (A, B) In the deep dermis, there is aggregation of multiple clear vacuoles and lipophages (HE A: ×40, B: ×400). (C) Absence of melanin pigments in the basal layer (Fontana-Masson, ... Our patient presented with hypopigmentation on the same locations of the paraffin injection sites, which began to develop 2 years after the injection. However, the lesions were also detected on the fingers and foot dorsum, which are frequently occurring sites of vitiligo. There have been case reports on the concurrence of vitiligo and chronic inflammatory disease such as psoriasis. For each associated diseases, several hypotheses have been suggested to explain a common pathogenesis, such as autoimmunity, Koebner phenomenon, involvement of neuropeptides, or decreased melanocytes and melanin4. In our case, the role of paraffin injection in the induction of vitiligo remains uncertain; however, the prolonged inflammation against paraffin had most likely damaged the melanocytes at the injection sites. To the best of our knowledge, this is the first report of vitiligo associated with paraffin injection. Although the foot lesion is remote from the injection site, we suggest that it is also possibly associated with the paraffin injection. The patient might have a vitiligo diathesis; thus, prolonged inflammation induced vitiligo, and then the autoimmunity caused the depigmentation on the foot. However, we cannot rule out that the vitiligo in this case is just a coincidence of paraffin injection. In conclusion, we report a rare case of vitiligo associated with paraffin injection. It is important that clinicians are aware of the potential pigmentary changes after paraffin injection.

Recurrent painful knee swelling

Recurrent painful knee swelling

Submandibular swelling: Tooth or salivary stone?

Submandibular swelling is a common clinical disorder of the maxillo-facial region that may be one of the manifestation of several pathologic disorders including sialolithiasis. A 38-year-old woman experienced a recurrent painful swelling in the right submandibular region for seven years. The symptoms, not always meal-related, gradually became chronic and associated with dysphagia, odynophagia and fever. Ultrasonography of the salivary glands revealed a retained glandular structure and no ductal obstruction or dilatation, and orthopantomography showed the presence of a structure compatible with tooth, but these findings did not correlate with clinical scenario. Only CT dental scan identified the radiological image as a salivary stone. Sialolithiasis should always be considered in the diagnostic iter of painful submandibular swelling. A careful evaluation of recurrence and characteristics of signs and symptoms associated to the swelling can help in making the correct diagnosis and planning a proper therapeutic strategy.