ABSTRACT
Rhinoscleroma is a chronic granulomatous condition of the respiratory tract, and is not uncommon in tropical regions; particularly, Mexico, Central America and the Middle East. A few cases have been reported in North America, primarily involving immigrants from endemic countries. The causative organism is Klebsiella rhinoscleromatis, a Gram-negative coccobacillus. Diagnosis is made on the basis of culture of the organism and the characteristic pathology of Mikulicz cells on light microscopy. The condition primarily affects the upper airway, and frequently presents with nasal discharge, nasal obstruction or frontal facial pain. Despite the term 'rhinoscleroma', there may be involvement of the entire respiratory tract. Although the condition is slowly progressive, its natural course portends extensive destruction. Laryngotracheal involvement occurs in approximately 15% to 80% of cases, but patients rarely present with isolated laryngotracheal disease. In the present paper, a case of rhinoscleroma presenting with symptoms of upper airway obstruction is described.
Subject(s)
Airway Obstruction/etiology , Airway Obstruction/pathology , Rhinoscleroma/complications , Rhinoscleroma/diagnosis , Biopsy, Needle , Follow-Up Studies , Humans , Immunohistochemistry , Male , Middle Aged , Rhinoscleroma/surgery , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Endocardial involvement associated with disseminated histoplasmosis has been infrequently documented, especially among patients with prosthetic valves. The therapeutic approach to these patients is also not yet clearly defined. A 54-year-old man with prosthetic valve endocarditis due to histoplasmosis was successfully treated with amphotericin B. A review of the literature suggests that the optimal form of therapy is likely a combination of surgical replacement of the involved valve and high dose amphotericin B. Successful therapy with amphotericin B alone may, however, be achieved if surgery is not a viable option.
Subject(s)
Amphotericin B/therapeutic use , Bioprosthesis , Endocarditis/microbiology , Heart Valve Prosthesis , Histoplasmosis/drug therapy , Endocarditis/drug therapy , Humans , Male , Middle Aged , Mitral ValveABSTRACT
A 67-year-old male presented with acute inferolateral myocardial infarction complicated by transient acute post infarction pericarditis. Six weeks later, he developed Dressler's syndrome associated with moderately severe anemia of chronic disease. Both of these resolved over the next few weeks, however, shortly thereafter, right sided congestive heart failure occurred. This progressed despite medical therapy and the diagnosis of constrictive pericarditis was made 10 months post infarction. Total pericardectomy was done one year after the onset of acute myocardial infarction with complete resolution of signs and symptoms.
