ABSTRACT
BACKGROUND: Necrotizing otitis externa is a potentially lethal form of otitis externa which occurs mainly in elderly diabetic. AIM: To study the clinical, diagnostic and therapeutic aspects of necrotizing otitis externa and to describe the outcomes of this disease. METHODS: We report in this retrospective study, a series of 36 patients treated in our department for necrotizing otitis externa over a period of 9 years. RESULTS: Our series consisted of 34 diabetics. The average age of our patients was 62 years. The diagnosis was based on clinical, biological and bacteriological data and on imaging findings. A medical treatment based on a systemic antibiotic therapy combining a third generation cephalosporin to a fluoroquinolone was prescribed in 24 cases and to an aminoglycoside in 12 cases. In addition, a local treatment was performed daily and included meticulous cleaning of the external auditory canal and topical application of antimicrobial agents. Surgical debridement of infected soft tissues and bone sequestra was indicated in 8 cases because of the lack of improvement with medical treatment. Only one patient underwent hyperbaric oxygen therapy. The cure rate was estimated at 86%. Only one death was noted. CONCLUSION: Necrotizing otitis externa is a severe infection. Its prognosis has improved markedly since the advent of antibiotics effective on Pseudomonas aeruginosa. Its management must be started without delay and its treatment must be prolonged.
Subject(s)
Ear, External/pathology , Otitis Externa/pathology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Necrosis , Otitis Externa/therapy , Retrospective Studies , Young AdultABSTRACT
Thyroid disorders are commonly associated with coagulopathy. Patients with hyperthyroidism have increased risk for developing thromboembolic accidents, which are favoured by a simultaneous presence of antiphospholipid antibodies syndrome. in this paper, we describe the case of a patient with Graves' disease, who developed strokes with antiphospholipid antibodies syndrome.
ABSTRACT
A case of acute generalised exanthematous pustulosis (AGEP) after cefotaxime use confirmed by a positive patch test is reported. A 30-year-old woman received cefotaxime, fosfomycin and ciprofloxacin for sinusitis. At 12 days after drug initiation, she developed an extending pustular erythaema associated with fever. Laboratory investigations showed marked leukocytosis. Her blood chemistry was normal. The histological examination showed parakeratosis, spongiosis and non-follicular intra epidermal pustules consistent with AGEP. All medications were withdrawn. The symptoms resolved within 11 days after cefotaxime discontinuation. Patch tests were positive to cefotaxime after 48 h, while ciprofloxacin and fosfomycin yielded negative findings. Based on the Naranjo algorithm, it is probable that the AGEP reaction was due to cefotaxime. To our knowledge, this is the first reported case of AGEP associated to positive cefotaxime patch testing.
