Leishmaniasis cutánea simuladora de pericondritis

Resumen La leishmaniasis cutánea presenta una clínica muy característica de pápula eritemato-amarillenta con costra central, en regiones expuestas, que los profesionales de la salud podemos identificar y tratar sin necesidad de biopsia. En ocasiones, se presenta con una clínica atípica que puede conducir a un error diagnóstico, con su perpetuación y malestar en el paciente. Presentamos el caso de una mujer de 53 con una placa eritema-to-exudativa por toda la extensión del pabellón auricular izquierdo de varios meses de evolución. Había sido tratada desde el inicio con antibioterapia y corticoides, sin conseguir mejoría y con un claro empeoramiento, al haberse extendido por toda la oreja. Tras la realización de la biopsia, se llegó al diagnóstico de leishmaniasis cutánea erisipeloide. Se procedió a realizar tratamiento dirigido con fluconazol y posteriores infiltraciones de antimoniato de meglumina consiguiendo su completa resolución.

Abstract Cutaneous leishmaniasis presents a very characteristic clinic of erythematous-yellowish papule with central crust, in exposed regions, that we health professionals can identify and treat without the need for a biopsy. Sometimes, it presents with an atypical clinic that can lead to a diagnostic error, with its perpetuation and discomfort in the patient. We present the case of a 53-year-old woman with an erythematous-exudative plaque throughout the extension of the left atrial pavilion of several months of evolution. It had been treated from the start with antiobiotherapy and corticosteroids, without achieving improvement and with a clear worsening, as it had spread throughout the ear. After the biopsy was performed, the diagnosis of erysipeloid cutaneous leishmaniasis was reached. Directed treatment with fluconazole and subsequent infiltrations of meglumine antimoniate were made, achieving its complete resolution.

Efficacy of costal cartilage cortex with retained costal perichondrium on nasal tip reconstruction / 中华医学美学美容杂志

Objective:To evaluate the advantages of cortical perichondrium retention of costal cartilage in tip plasty.Methods:A total of 618 female cases were retrospectively analyzed from July 2017 to July 2018 in Zhengzhou Meilai Medical Beauty Hospital that underwent comprehensive line of rib cartilage rhinoplasty for beauty, aged 18-52 years with mean 27±6 years. According to different modification graft used in plasty, the cases were divided into reserve costal perichondrium cortex group (experimental group) and simple rib cartilage cortex group (control group). Statistical analyses were carried out 1 month and 12 months after operation. The tip displacement visualization was compared between the two groups and the advantages and disadvantages were evaluated in both.Results:After the surgery of the 618 patients, the rate of displacement in the experimental group was 3.6%, and that in the control group was 7.9% (χ 2=4.95, P<0.05). The rate of the implant exposure in the experimental group was 4.7%, and that in the control group was 9.1% (χ 2=4.38, P<0.05). The reserve costal perichondrium cortex used in the nasoplasty kept the prominent and stable nasal tip after the operation, and longterm follow-up showed there were no displacement and deformation occured in the patients. Conclusions:The application of costal cartilaginous cortex retaining costal perichondrium in tip plasty can obtain good nasal tip protrusion and stable rotation. It is an ideal nasal tip shaping material and worthy of clinical application.

Infected transcartilaginous ear piercings. A case report and review of the literature / Pericondritis del pabellón auricular por piercings. Reporte de un caso clínico y revisión de la literatura

Background: transcartilaginous perforations have become a prominent practice among adolescents and young adults in recent years,which are associated with an increased risk of complications since it is frequently performed without sterile technique and by unqualified individuals. The transgression of the integrity of the skin and cartilage of the ear favors infections such as cellulitis, chondritis, perichondritis or abscesses that can cause serious deformities. Methods: we present a clinical case compatible with a perichondritis secondary to ear perforations with three abscesses. Results: the three abscesses were drained with sterile technique and successfully managed with outpatient antibiotic treatment. In relation to the pathophysiology, the trauma in the auditory pavilion produces the extraction of the adjacent perichondrium, causing devascularization of the cartilage and microfractures, which together with the transgression of the skin, increase the susceptibility to infection. In addition, subpericardial bleeding and inflammatory reaction decrease the blood supply, which limits the immune response and the effectiveness of antibiotics. In some cases, incision and drainage are required. The signs of perichondritis include pain, swelling, and erythema of the skin. Clinically, perichondritis can be differentiated from cellulitis of the pinna, in that the first usually does not involve the earlobe. The fluctuating swelling leads us to an abscess. Conclusions: the administration of broad-spectrum antibiotics should be immediately administered and include coverage for Pseudomonas aeruginosa since it is responsible for the majority of post-perforation cartilage infections (up to 95 percent of cases). Due to the increase of post-perforation infectious complications, all physicians should be familiar with its diagnosis and treatment.(AU)

Antecedentes: las perforaciones transcartilaginosas se han convertido en una práctica destacada entre adolescentes y adultos jóvenes en los últimos años, que están asociados con un mayor riesgo de complicaciones, ya que se realiza con frecuencia sin técnica estéril y sin calificación individuos. La transgresión de la integridad de la piel y el cartílago del oído favorece infecciones como la celulitis, la condritis, la pericondritis o los abscesos que pueden causar graves deformidades. Métodos: presentamos un caso clínico compatible con una pericondritis secundaria a las perforaciones del oído con tres abscesos. Resultados: los tres abscesos se drenaron con técnica estéril y se manejaron con éxito con tratamiento antibiótico ambulatorio. En relación con la fisiopatología, el trauma en el pabellón auditivo produce la extracción. del pericondrio adyacente, causando la desvascularización del cartílago y las microfracturas, que junto con la transgresión de la piel, aumenta la susceptibilidad a la infección. Además, el sangrado subpericárdico y la reacción inflamatoria disminuyen la sangre. suministro, lo que limita la respuesta inmune y la efectividad de los antibióticos. En algunos casos, se requiere incisión y drenaje. los Los signos de pericondritis incluyen dolor, hinchazón y eritema de la piel. Clínicamente, la pericondritis puede diferenciarse de la celulitis de el pinna, ya que el primero generalmente no involucra el lóbulo de la oreja. La hinchazón fluctuante nos lleva a un absceso. Conclusiones: la administración de antibióticos de amplio espectro debe administrarse inmediatamente e incluir cobertura para Pseudomonas aeruginosa desde Es responsable de la mayoría de las infecciones de cartílago posteriores a la perforación (hasta el 95 por ciento de los casos). Debido al aumento de post-perforación complicaciones infecciosas, todos los médicos deben estar familiarizados con su diagnóstico y tratamiento...(AU)

Two Cases of Post-piercing Auricular Perichondritis Caused by Pseudomonas aeruginosa / 대한피부과학회지

Piercing of various parts of the body is common practice in Korea nowadays. In particular, ear piercing appears to be increasingly prevalent among adolescents and young-adults. Because of the complication of the procedure, auricular perichondritis after piercings can arise in this patient population. Staphylococcus aureus and Pseudomonas aeruginosa are the most common causative organisms associated with infections due to ear piercing. In most cases, however, the patients were not prescribed anti-pseudomonal antimicrobial agent at presentation. This may result in persistent complicated infection and permanent cosmetic deformities. Herein, we describe two cases of post-piercing auricular perichondritis caused by P. aeruginosa successfully treated with intravenous antimicrobial agents. Also, a literature review of auricular perichondritis after ear piercing was done.

A dinicai study of 27 cases with suppurative perichondritis of auricle / 中国基层医药

ObjectiveTo investigate the methods of treatment and effect in suppurative perichondritis of auricle.Methods27 cases with suppurative perichondritis of auricle were mentioned with sensitive antibiotic treatment in the whole and partly of the body.Carve and extradite the cases of abscess till entire debridement.ResultsAfter follow-up for 6 to 12 months,all 27 cases of auricles were preserved without feeling of causalgic.The efficient rate was 100％.Although 5 cases of auricle's shape were shrinked,the others preserved a good shape of auricle.The relief rate was 81.5％.ConclusionThe effective way of treating suppurative perichondritis of auricle was using sensitive antibiotic and entire debridement.

Pericondrite pós-piercing / Post-piercing perichondritis

O uso de piercing tem se tornado uma prática muito freqüente entre os jovens. O procedimento na maioria vezes realizado por profissionais não-qualificados não é isento de riscos. O manuseio de material contaminado ou a higiene imprópria predispõem à pericondrite e à celulite. A pericondrite caracteriza-se pelo eritema do pavilhão auricular, dor intensa e febre. Sem tratamento, desenvolve-se um edema generalizado do pavilhão com formação de abscesso subpericondrial, podendo evoluir para necrose isquêmica da cartilagem e a temível deformidade estética conhecida como "orelha em couve flor". O agente responsável mais encontrado é o Pseudomonas aeruginosa. No estágio inicial da doença o tratamento pode ser feito com antibióticos de amplo espectro. Nos casos em que o abscesso está presente, a incisão e drenagem cirúrgica são obrigatórios acompanhado de antibioticoterapia guiado pela cultura e antibiograma. OBJETIVO: O objetivo deste relato de caso é realizar uma revisão bibliográfica dos últimos 10 anos abordando os aspectos anatômicos do pavilhão auricular, a história do uso de piercing e suas mais conhecidas complicações. MÉTODO: Relato de um caso de pericondrite pós-piercing transcartilaginoso onde houve a necessidade de tratamento cirúrgico com praticamente nenhuma deformidade estética. RESULTADO: Aquisição de experiência teórico-prática através de revisão bibliográfica e relato de um caso de evolução favorável para a paciente. CONCLUSÃO: Incidência crescente das complicações de pericondrites na população jovem deve levar à prevenção primária mais elaborada.

Piercing has become more and more popular among adolescents. The procedure is generally performed by unqualified professionals and carries its risk. Non-sterilized material or inappropiate hygiene increases the possibility of perichondritis and celulitis. The disease is characterized by erythema of the auricula pinna, unbearable pain and fever. Left untreated, the condition progresses with edema along the auricula and abscess formation that may result in ischemic necrosis and a cauliflower anesthetic deformation. The most common bacteria is Pseudomonas aeruginosa. In cases with abscesses, drainage is necessary along with antibiotic therapy guided by cultures and antibiogram. AIM: The aim of this case report was to review the past 10 years of published papers dealing with anatomical aspects of the auricular pinna, the history of piercing and its most common complications. METHODS: A case report of perichondritis after "high" ear piercing that required surgical treatment and that progressed with no esthetic loss. RESULTS: Theoretical and practical experience based on a review and a report of a case that progressed satisfactorily. CONCLUSIONS: The increased incidence of perichondritis in adolescents should require more elaborated primary prevention measures.