ABSTRACT
We present a case of a 55-year-old lady with intermittent twitching of the left side of her face, involving her left eyelid and the angle of the mouth, ongoing for two years. She failed multiple trials of botulinum toxin injections as well as oral anti-spasmodic medications. The patient was diagnosed with an ectatic left vertebral artery, causing a compression of cranial nerve VII on the same side on magnetic resonance imaging (MRI) of the brain. She underwent neurosurgery with a microvascular decompression of the ectatic artery with a resolution of hemifacial spasms. However, her postoperative course was complicated by headaches and low-grade fevers. She also had leukocytosis on a laboratory evaluation. The postoperative computed tomography (CT) scan of her head was normal. The patient had a lumbar puncture done, which showed an elevated white cell count in cerebrospinal fluid (CSF) analysis and the CSF culture was positive for methicillin-resistant Staphylococcus aureus (MRSA) bacteria. She was diagnosed with MRSA meningitis as a postoperative complication following microvascular decompression. The patient had a revision surgery of the decompression site, including wound debridement and did well postoperatively.
ABSTRACT
BACKGROUND: The aspirin exacerbated respiratory disease (AERD) shows a prevalence of 7% among asthmatics and increases to 14% in patients with difficult to control asthma. Treatment includes the use of inhibitors of leukotriene receptor (), intranasal steroids, polypectomy, asthma management according to the severity and avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs). In some patients it is necessary desensitization protocol to it. CLINICAL CASES: Two patients diagnosed with respiratory disease exacerbated by aspirin, with poor asthma control and need for multiple polypectomies, despite optimal pharmacological management, carrying out protocol desensitization to aspirin (AAS) successful, now after 4 years of having carried out, they have adequate asthma control without need for polypectomies with a maintenance dose of aspirin 150 mg/day.
Antecedentes: la prevalencia de enfermedad respiratoria exacerbada por aspirina es de 7% en pacientes asmáticos y se incrementa, incluso, a 14% en pacientes con asma de difícil control. El tratamiento incluye la prescripción de inhibidores de los receptores de leucotrienos, esteroides intranasales, polipectomías, tratamiento del asma según su severidad y evitar los antiinflamatorios no esteroides. En algunos pacientes es necesario realizar el protocolo de desensibilización a la aspirina. Casos clínicos: se describen 2 mujeres con diagnóstico de enfermedad respiratoria exacerbada por la administración de aspirina, con escaso control de los cuadros de asma y a quienes fue necesario realizar múltiples polipectomías, a pesar del manejo farmacológico óptimo. Se llevó a cabo protocolo de desensibilización a aspirina (AAS); la respuesta fue positiva. Después de cuatro años, las pacientes presentan adecuado control del asma, con una dosis de mantenimiento de AAS de 150 mg/ día y no han requerido polipectomías.
