Síntomas faríngeos como primera manifestación clínica en un paciente con Histoplasmosis generalizada / Pharyngeal symptoms as first clinical manifestation in a patient with Generalized Histoplasmosis

Introducción: La Histoplasmosis es una enfermedad endémica, que presenta un comportamiento oportunista cuyo germen causal es el Histoplasma capsulatum (HC), considerado un hongo dimórfico. Objetivo: Presentar un caso con el diagnóstico de Histoplasmosis generalizada, cuyas manifestaciones faríngeas fueron el inicio de la enfermedad. Presentación del caso: Se presenta el caso de un paciente, con los síntomas faríngeos que fueron la primera manifestación de la enfermedad, en el que la biopsia permitió llegar al diagnóstico nosológico. Posteriormente presentó otras manifestaciones con aspectos clínicos-microbiológicos de diseminación progresiva. Conclusiones: La Histoplasmosis faríngea es una micosis sistémica infrecuente y de difícil diagnóstico, es preciso un buen interrogatorio y examen físico, en aquellos pacientes con factores de riesgo de enfermedades infecciosas sin diagnóstico aparente y deterioro progresivo de su estado general(AU)

Introduction: The Histoplasmosis is an endemic illness that presents an opportunist behavior in which causal germ is the Histoplasma capsulatum (HC), considered a dimorphic mushroom. Objective: To present a case with the diagnosis of Generalized Histoplasmosis in which pharyngeal manifestations were the beginning of the illness. Presentation of the case: The case of a patient is presented with the pharyngeal symptoms that were the first manifestation of the illness, in which the biopsy allowed to arrive to the diagnostic. Later the patient presented other manifestations with clinical-microbiologic aspects of progressive dissemination. Conclusions: The pharyngeal Histoplasmosis is an uncommon systemic mycosis and with a difficult diagnostic, it is necessary a good interrogation and physical exam, in those patients with factors of risk of infectious illnesses without apparent diagnosis and progressive deterioration of their general state(AU)

Absceso tiroideo con fístula del seno piriforme: tres casos clínicos / Thyroid abscess with pyriform sinus fistulae: 3 clinical cases

Thyroid abscess is an infrequent, potentially life-threatening condition. It accounts for 0,1 to 0,7 percent of thyroid pathology, usually occurring in patients with preexisting disease of the gland or more commonly, associated to local anatomical defects, such pyriform sinus fistulae. Three cases of thyroid abscess in children are presented, in which no bacterial etiology was confirmed. Intravenous antibiotics were used, cefotaxime, cloxacillin or clindamicin. Recurrence was confirmed in 2 of them, and a pyriform sinus fistulae was demostrated by esophagogram.

El absceso tiroideo es un cuadro infrecuente y una emergencia endocrina potencialmente fatal. Representa el 0,1 a 0,7 por ciento de las patologías tiroideas. Habitualmente se produce en pacientes con patología preexistente de la glándula o más frecuentemente, asociado a defectos anatómicos locales, como una fístula del seno piriforme. Presentamos 3 casos de abscesos tiroideos en escolares. Recibieron tratamiento antibiótico endovenoso de amplio espectro, a pesar de lo cual dos de ellos recidivaron precozmente. En dos de ellos se demostró una fístula del seno piriforme con esofagograma que se manejó quirúrgicamente.

Acute Retropharyngeal Calcific Tendinitis in an Unusual Location: a Case Report in a Patient with Rheumatoid Arthritis and Atlantoaxial Subluxation

Retropharyngeal calcific tendinitis is defined as inflammation of the longus colli muscle and is caused by the deposition of calcium hydroxyapatite crystals, which usually involves the superior oblique fibers of the longus colli muscle from C1-3. Diagnosis is usually made by detecting amorphous calcification and prevertebral soft tissue swelling on radiograph, CT or MRI. In this report, we introduce a case of this disease which was misdiagnosed as a retropharyngeal tuberculous abscess, or a muscle strain of the ongus colli muscle. No calcifications were visible along the vertical fibers of the longus colli muscle. The lesion was located anterior to the C4-5 disc, in a rheumatoid arthritis patient with atlantoaxial subluxation. Calcific tendinitis of the longus colli muscle at this location in a rheumatoid arthritis patient has not been reported in the English literature.

CT Analysis of Retropharyngeal Abnormality in Kawasaki Disease

OBJECTIVE: To retrospectively compare the imaging characteristics of retropharyngeal density and associated findings for Kawasaki disease with those for non-Kawasaki disease, and identify the distinguishing features which aid the CT diagnosis of Kawasaki disease with retropharyngeal low density. MATERIALS AND METHODS: Among the enhanced neck CT performed in children less than 8-years old with clinical presentation of fever and cervical lymphadenopathy over a 6-year period, only cases with retropharyngeal low density (RLD) were included in this study. The 56 cases of RLD were divided into two groups; group A included cases diagnosed as Kawasaki disease (n = 34) and group B included cases diagnosed as non-Kawasaki disease (n = 22). We evaluated the CT features including the thickness of RLD and its extent into the deep neck spaces, as well as soft tissue change in the adjacent structure. We also scored the extent of RLD into the deep neck spaces and the soft tissue changes in the adjacent structure. RESULTS: The thickness of RLD was greater in group A than in group B (group A, 6.0 +/- 2.1; group B, 4.6 +/- 1.5, p = 0.01). The score of the RLD extent into the deep neck spaces was significantly greater in group A than in group B (group A, 2.3 +/- 1.3; group B, 0.8 +/- 1.0, p < 0.01). Also, the score of the adjacent soft tissue changes was greater in group A than in group B (group A, 2.0 +/- 1.1; group B, 1.0 +/- 1.0, p < 0.01). CONCLUSION: If children present with fever and cervical lymphadenopathy that display retropharyngeal low density with extension into more deep neck spaces as well as changes in more adjacent soft tissue, the possibility of Kawasaki disease should be considered.

Tuberculosis en faringe y laringe: presentación de un caso / Tuberculosis in pharyn and larynx: case presentation

La tuberculosis, infección bacteriana crónica causada por el Mycobacterium tuberculosis, declarada por la OMS (1993) como emergencia epidemiológica, afecta mayoritariamente los pulmones, pero puede afectar a otros órganos (Tb. Extrapulmonar), entre estos a la laringe, constituyendo la más frecuente enfermedad granulomatosa a este nivel y considerada una localización rara (menos de 1 por ciento); por ello nuestro interés de presentar un caso de Tuberculosis en faringe y laringe, con el objetivo de resaltar lo infrecuente de esta ubicación, los problemas diagnósticos y la importancia del estudio histopatológico. Paciente de 49 años, femenina, consulta por Odinofagia, se encuentra tumor en faringe, se realiza biopsia y el diagnóstico fue: Sarcoidosis faríngea, no regresó a consulta. Meses después asiste por disfonía, se visualiza tumor en laringe, se realiza biopsia y el informe fue carcinoma de laringe; se negó a tratarse. Cuatro meses más tarde, ingresa en el Hospital Neumológico, por disnea, tos y disfonía, el diagnóstico fue tuberculosis pulmonar (Cod 9). Interconsultan con Otorrinolaringología el tratamiento del cáncer laríngeo. Decidimos nueva revisión de las biopsias, y se arribó a las conclusiones siguientes: "Tuberculosis miliar acorde con su cuadro clínico y hallazgos anatomo-patológicos: (faringitis y laringitis granulomatosa); no se corresponde ni con Sarcoidosis ni con carcinoma Epidermoide previamente reportado.".

Tuberculosis is a chronic bacterial disease caused by Mycobacterium tuberculosis, declared by WHO in 1993 as epidemilogical emergency warning, affecting mostly the lungs but it can also damage others organs (Extra lung Tb) such as the larynxbeing the most frequent granulomatous disease as this level and it considered as a rare location (less than 1 percent), that is why we are so interested in presenting this case report of larynx and pharynx disease, with the aspiration to highlight how few are the cases with this location, the diagnostic problems and the importance of a histopathologic analysis. 49 years, female patient came to the consultation because of odenaphagia. A pharyngeal tumour was diagnosed and a biopsy was undergone which revealed pharyngeal Sarcoidosis. The patient did not come back to the consultation until several months later due to diphonia. A tumour in the larynx is visualized and a biopsy is undergone again which shoved to the positive for laryngeal cancer; the patient refuses to be treated. Four months later the patient is admitted to the hospital in the Neumology hospital with a clinical picture of dyspnea, cough and dysphonic. The diagnosis was pulmonary tuberculosis. A consult is carried out which the otorrhynolaringologyst and a new consideration came out, concluding by pathological anatomy as tuberculosis. Taking into account the clinical picture and the anatomopathological firdings that do not corresponded inther with Sarcoidosis or Epidermoide carcinoma previously reported. The characteristics of this case led to this presentation

unusual presentation of Lemierre syndrome

Lemierre syndrome is an entity defined by septic thrombophlebitis of the internal jugular vein following an oropharyngeal infection, which is usually acute and complicated by metastatic infection in different organs. The usual causative organism is Fusobacterium necrophorum. On looking back at the case reports of Lemierre syndrome, we have found different sites of primary infection and also different presentations depending on the primary site and the site of involvement resulting from metastatic septic embolization. However, chronic otitis media as the primary site of infection and bloody diarrhea as the presenting symptom were very rarely presented. The case presented here was referred to Faghihi hospital of our academic medical center with bloody diarrhea. After work ups, the patient was diagnosed as a case of Lemierre syndrome on the base of chronic otitis media

Amiloidose com múltiplos focos em trato aéreo-digestivo superior: relato de caso e revisão de literatura / Multiple-sited amyloidosis in the upper aerodigestive tract: case report and literature review

Há na literatura inúmeras descrições de amiloidose limitada à laringe, sendo que esta afecção corresponde a cerca de 1 por cento dos tumores benignos da laringe. Entretanto, há somente três relatos de amiloidose acometendo a região do anel de Waldeyer. Descreveremos um raro caso de amiloidose em que há acometimento de sítios distintos do trato aéreo-digestivo superior: pilar amigdaliano, rinofaringe, supraglote e glote, sem continuidade aparente do tecido amilóide. Abordaremos, também, o seguimento pós-operatório com uma disfagia grave.

There are some reports of localized amyloidosis in the larynx, an entity that corresponds to one percent of all benign tumors of this region. However, there are only two cases of amyloidosis in the Waldeyer's ring 6, 13, 14. We hereby describe a rare case of amyloidosis in areas not associated with the upper aero-digestive tract: tonsil pillar, rhinopharynx, supraglottis and glottis, without visible continuity of amyloid tissue. We will also discuss post-operative follow up with severe dysphagia.

Anomalías en el desarrollo del cuarto aparato faríngeo como causa de infecciones profundas del cuello recidivantes / Anomalies in the fourth pharyngeal apparatus as cause of deep recidivant neck infections

La mayoría de las infecciones profundas del cuello se originan a partir de un foco en la mucosa aerodigestiva superior o a partir de un foco dental, las anomalías congénitas corresponden sólo a 2 por ciento de las causas. La presentación clínica es bastante similar independientemente de la etiología y en muchas ocasiones no basta con la clínica para llegar a un correcto diagnóstico etiológico. La presencia de una infección del espacio profundo del cuello (IEPC) a repetición es altamente sugerente de una anomalía congénita de las cuales aproximadamente el 58 por ciento derivan del aparato faríngeo. De éstas, las provenientes del IV aparato faríngeo son extremadamente raras siendo más frecuentes en la niñez, en el lado izquierdo del cuello y en pacientes de sexo femenino. Estas IEPC de causa congénita también tienen una buena respuesta a la terapia antibiótica y/o al drenaje por lo tanto ello lo enmascara como un factor etiológico. Realizar el diagnóstico de anomalía del desarrollo del IV aparato faríngeo es difícil. Ellas son poco frecuente (1-2 por ciento de las anomalías congénitas) y clínicamente se presentan como abscesos recurrentes del espacio profundo del cuello, al lado Izquierdo, generalmente en la niñez, acompañados o no de una tiroiditis aguda supurada izquierda asociado al hallazgo del orificio persistente (seno) en el ápex del seno piriforme. Se comunican 3 pacientes con absceso cervical izquierdo secundario a una anomalía en el desarrollo del IV aparato faríngeo.