Tonsillar tuberculosis mimicking tonsillar carcinoma: A case report.

INTRODUCTION: Extrapulmonary tuberculosis is rare even in endemic areas, and is dominated by lymph node involvement. Tonsillar tuberculosis is exceptional. The clinical examination and radiological explorations are non-specific. CASE PRESENTATION: A 45-year-old woman presented with chronic odynophagia and otalgia. Examination revealed an enlarged left palatine tonsil with an irregular surface and a firm consistency. Radiologic exploration was not specific. The patient underwent a tonsillar biopsy. Histopathology was consistent with tuberculosis and the patient was put on antitubercular drugs. CLINICAL DISCUSSION: Tuberculosis is a global public health problem. Extrapulmonary tuberculosis is rare and mainly affects lymph nodes. Tonsillar tuberculosis is frequentely seen in individuals with immunodeficiency. Clinical features and imaging findings are non-specific. Diagnosis is based on histopathological and microbiological findings to rule out differential diagnoses especially cancer. Treatment is based on anti-tuberculosis drugs. CONCLUSION: Our case illustrates a rare presentation of primary tuberculosis and highlights the importance of considering tuberculosis as a potential cause of tonsillitis.

Multiple Retained Needles in the Neck of a Drug User: A Case Report.

Retained needles are frequently observed in intravenous drug users. However, an incidental discovery of multiple needles at the neck seldom occurs. These foreign bodies remain either asymptomatic or cause local and central complications that can be fatal. We report the case of a 43-year-old male having a medical record of human immunodeficiency virus and hepatitis C who presented to our department with a 3-day history of a febrile lateral neck swelling. He reported a history of repetitive intravenous drug use and previous abscesses that were surgically drained. We noted a left and tender 8 cm neck swelling with torticollis. Computed tomography scan showed a collected myositis of the sternocleidomastoid muscle in association to multiple metallic foreign bodies at the neck that were compatible with the aspect of broken needles. Imagery also showed a thrombosis of the ipsilateral jugular vein. No central embolism of a foreign body was noted. We performed a surgical drainage of the muscular abscess and managed to retrieve a 1 cm broken needle that was retained at the level of the collection. We did not retrieve the other needles since they were asymptomatic. The patient was placed under intravenous antibiotics for 1 week followed by oral amoxicillin-clavulanate with a total regression of the cellulitis. At the further follow-ups, the rest of the foreign bodies remained asymptomatic. Our study emphasizes on the importance of suspecting a retained foreign body in intravenous drug users to ensure an adequate management of the possible complications and to protect the medical team from incidental needle injuries.

Hydatid cyst in the parotid gland, a rare localization of the disease: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid cysts are often found in the liver or lungs. As for the parotid localization, it remains exceptional even in endemic areas and presents as a tumor of the parotid thus representing a challenge to the practitioner. CASE PRESENTATION: A 54-year-old male farmer presented with a swelling in the left parotid gland region evolving over the past 2 years. Physical examination revealed a non-tender and mobile swelling in the left parotid region, the overlying skin was normal. Magnetic resonance imaging showed a cystic lesion of the left parotid gland. Fine-needle aspiration cytology (FNAC) yielded a clear fluid with a few benign epithelial cell. A superficial parotidectomy was performed. Histopathological examination confirmed the presence of a hydatid cyst in the parotid gland. CLINICAL DISCUSSION: Parotid hydatid cyst is exceptional. However, it can be suspected in the context of an isolated parotid cystic mass in an endemic area, even in the absence of any other associated location. CONCLUSION: Hydatid cysts of the parotid gland have a polymorphic and a specific symptomatology and require surgical removal.

A superior ophthalmic vein thrombosis following an acute pansinusitis: A case report.

INTRODUCTION AND IMPORTANCE: Superior ophthalmic vein thrombosis (SOVT) is a very rare condition that can occur following either septic or aspetic causes. Early recognition and management is important in order to avoid vision-threatening and fatal complications. CASE PRESENTATION: A 28-year-old man presented with orbital cellulitis complicating acute pansinusitis. CT scan revealed ipsilateral SOVT. The patient received intravenous antibiotics and anticoagulation with strict ophthalmic monitoring. No orbital complications were recorded during the course of treatment. CLINICAL DISCUSSION: SOVT is caused either by septic or aseptic causes. Treatment depends on the etiology. Corticosteroids and anticoagulants are controversial. CONCLUSION: Early diagnosis is key to successful management of SOVT.

Otomyiasis caused by Musca domestica in a child: A case report.

INTRODUCTION: Myiasis is the infestation of humans and vertebrate animals with dipterous larvae. It is a rare clinical condition, mainly observed in vulnerable people living in tropical and subtropical regions. CASE PRESENTATION: We reported a 2-year-old boy, with history of anemia and psoriasis who was admitted to our department after discovering larvea coming out from the left ear 6 weeks ago. Ear examination revealed a few maggots in the left concha and external auditory canal. A larvea was removed and identified as Musca domestica. Management of this otomyiasis was based on manual maggot removal and regular auditory toilets with povidone iodine. DISCUSSION: Although rarely reported, clinicians should still suspect aural myiasis in the event of an unexplained otalgia in children, mainly if they are from rural area with poor hygienic conditions. CONCLUSION: Otomyiasis is mainly reported in tropical rural location in debilitated individuals with low socioeconomic conditions and poor hygiene. Thus prophylactic measures are the most effective means to reduce its incidence.

Hydatid disease as a rare cause of neck swelling: Two cases report.

INTRODUCTION: Despite the fact that hydatid disease is endemic in some countries, its cervical location remains very rare. PRESENTATION OF CASE: We report two cases of primary cervical hydatid disease in two children from rural areas. The imaging was not specific, since the location is rare; the diagnosis was only confirmed after surgery. DISCUSSION: Hydatid cyst is a rare pathology. Thus clinical presentation, radiological examinations, fine needle aspiration and serology can be useful to suspect the diagnosis. CONCLUSION: Hydatid disease should be considered when dealing with slow-growing renitent neck swelling in endemic countries.

Successful treatment of rhino-facial mucormycosis in a diabetic patient.

Mucormycosis is a rapidly progressing and lethal infection caused by fungi of the order mucorales. The disease occurs mostly in patients with uncontrolled diabetes or other predisposing systemic conditions. We report a case of rhinofacial mucormycosis in a 39-year-old diabetic patient. The diagnosis was established by clinical examination, imaging, and confirmed by mycological examination. Rhizopus arrhizus was isolated. He was successfully treated with amphotericin B, surgical resection, diabetes control and hyperbaric oxygen therapy.