Ranula as the First Symptom of HIV Infection in Young Patients.

INTRODUCTION: Oral manifestations are often the earliest HIV signs. Salivary gland diseases are a common form of HIV expression. A ranula can occur in association with HIV. However, this manifestation is rarely considered as the disease sentinel sign. We present two cases of children consulting for a ranula, leading to the diagnosis of a previously unknown HIV infection. Case Reports. Two children, respectively, 5 and 13, were treated for a ranula by marsupialization. Relapse occurred in both cases, and thereafter, a ranula excision was performed. While the follow-up was uneventful, HIV infection was diagnosed during the patients' care. The only sign or symptom observed was the ranula. A routine HIV testing of ranula patients would have allowed earlier care. CONCLUSION: Routine HIV testing of patients with a ranula is justified and may be recommended, especially for children. Ranula excision associated with the sublingual gland resection is suggested in order to avoid recurrence.

MALDI-TOF MS contribution to the diagnosis of Campylobacter rectus multiple skull base and brain abscesses.

Campylobacter rectus is rarely associated with invasive infection. Both the isolation and the identification requirements of C. rectus are fastidious, probably contributing to an underestimation of its burden. We report the case of a 66-year-old man who developed several skull base and intracerebral abscesses after dental intervention. Campylobacter rectus was isolated from the brain biopsy. Within 45 minutes of reading the bacterial plate, the strain was accurately identified by MALDI-TOF MS. This rapid identification avoided the extra costs and delays present with 16S rRNA gene sequencing and allowed for a rapid confirmation of the adequacy of the empirical antibiotic treatment.

[Chronic maxillary rhinosinusitis of dental origin: report of 2 cases]. / Rhinosinusites chroniques maxillaires d'origine dentaire : à propos de 2 cas.

Chronic maxillary rhinosinusitis of dental origin represents approximately 5 % of chronic maxillary rhinosinusitis. The diagnosis of this pathology is often delayed and mainly based on endoscopy and medical imaging. Its treatment is complex and requires the involvement of several teams. This article discusses two cases of chronic maxillary rhinosinusitis secondary to dental treatment. A literature review on the epidemiology, diagnosis, treatment and complications are also introduced.

[Staphylococcus aureus bacteremia and epidural mass in a patient with tophaceous gout]. / Bactériémie à Staphylococcus aureus et masse épidurale chez un patient souffrant d'une goutte tophacée.

We present a case of Staphylococcus aureus septicaemia complicated with endocarditis and spondylodiscitis C2-C3 with compressive epidural mass in a 74-year old patient with a history of gouty arthritis and aortic prosthetic valve. Tophaceous material has been found when surgical decompression of the abscess has been performed. Staphylococcus aureus bacteremia is a serious and common infection with high mortality and complication rate. Amongst those complications, endocarditis is more likely to develop if cardiac prosthetic valve is present. The probability of a metastatic infection may be evaluated by several factors, such as: the time to positivity of blood culture, a community-acquired Staphylococcus aureus bacteremia and the presence of Osler nodes. All were present in our case. In fact, spondylodiscitis C2-C3 with compressive epidural mass was discovered, which was suspected to be an epidural abscess. Epidural abscess is a rare but potentially life-threatening disease that remains often underdiagnosed. Diagnosis is made by imaging and anatomopathological findings. In the case of our patient the finding of tophaceous material raises the issue of the nature of the epidural lesion. Spinal involvement with gout has been described. It can mimic epidural abscesses, most often in an infectious context as it was the case of our patient.

Different presentations of ophthalmic aspergillosis.

PURPOSE: Aspergillus species is found worldwide and does not normally cause disease. However, when the immune system is compromised, it can invade many organs and be responsible for severe disease. The authors present cases with both classical and atypical features of ophthalmic aspergillosis. METHODS: Case series of three patients. RESULTS: All patients were female and had a long history of methylprednisolone use. The first two presented with endogenous endophthalmitis. One case was unilateral with a classical presentation of endophthalmitis. The other presented with a very severe bilateral acute retinal necrosis like syndrome. General work-up revealed disseminated disease in both cases. The diagnosis was made by serum immunologic testing in one case and after direct examination and culture from vitrectomy in the other. Despite intense antimycotic therapy, both patients died. The third patient presented with a unilateral progressive painful orbital apex syndrome. An orbital lesion was demonstrated by computed tomography scan and was unresponsive to methylprednisolone. Diagnosis of sino-orbital syndrome was made on biopsy. The lesion responded poorly to different antimycotic therapies, invaded the chiasma, and the patient lost all visual acuity. CONCLUSIONS: This case series illustrates that ophthalmic aspergillosis can present acutely with a devastating intraocular inflammation or more indolently in the setting of sino-orbital aspergillosis. Both forms have a poor visual prognosis and the systemic form is frequently associated with a fatal outcome.

[Mandibular ameloblastic fibro-odontoma]. / Fibro-odontome ameloblastique mandibulaire.

Ameloblastic fibro-odontoma is a rare and benign tumor. It usually affects young patients. This report describes the case of a ten year old child presenting an asymptomatic and slow-growing tumor located in the posterior region of the mandible. The course was normal and no recurrence was found after simple enucleation of the tumor.

CT and 99mTc-DMSA scintigraphy in adult acute pyelonephritis: a comparative study.

PURPOSE: The aim of this prospective study was to evaluate the relative value of CT and (99m)Tc-DMSA scintigraphy in the diagnosis of acute pyelonephritis (APN) in adult patients suspected of having urinary tract infection. METHOD: The study was conducted in 36 patients presenting with symptoms suggestive of urinary tract infection. Plain B-mode sonography, CT with contrast medium, and (99m)Tc-DMSA scintigraphy of the kidneys were performed in all patients. Both CT and (99m)Tc-DMSA scintigraphy were performed within 72 h after admission. RESULTS: Twelve patients with clinical and biological signs of urinary tract infection had no CT or (99m)Tc-DMSA scintigraphy abnormalities. Among these patients, lower urinary tract infection was found in 10 patients and 2 patients had ureteral obstruction. In the 24 remaining patients, the diagnosis of APN was made. Among these patients, a correlation was found between CT and (99m)Tc-DMSA scintigraphy in 11 cases. In two cases, both examinations were normal, and in nine cases, both were abnormal. In 11 cases of the 13 remaining patients, abnormal CT was found with normal (99m)Tc-DMSA scintigraphy, whereas the 2 last cases had normal CT and abnormal (99m)Tc-DMSA scintigraphy results. In two cases, bilateral lesions found on CT manifested as unilateral abnormalities on (99m)Tc-DMSA scintigraphy images. CONCLUSION: The diagnosis of APN in adult patients is based on clinical presentation and biological findings. Few studies have compared (99m)Tc-DMSA scintigraphy with CT in the detection of parenchymal involvement in APN. We conclude that CT is more accurate than (99m)Tc-DMSA scintigraphy in the detection of APN lesions in adult patients.

[Chronic post-traumatic extradural and epicranial pneumatocele. A rare complication of skull base fracture]. / Pneumatocèle extra-durale et épicrânienne chronique post-traumatique. Une rare complication d'une fracture de la base du crâne.

A case of chronic epidural and epicranial pneumocephalus in a 31-year-old man with a history of head trauma and progressive development of a soft tissue mass in the occipital region is reported. Its hypothetical pathogenesis and pathophysiology are discussed.

Tonsillar lymphoma and AIDS.

A case of a patient presenting unilateral tonsillar enlargement, whereby non-Hodgkin lymphoma (NHL) and AIDS were diagnosed, is presented. The clinical and pathological aspects of this pathology, its pathogenicity and treatment are reviewed.

Laryngeal aspergillosis in an acquired immunodeficiency syndrome patient.

Aspergillosis is a rare infection. It varies considerably in its virulence depending on whether or not the patient affected is immunodepressed. The serious form is characterized by vascular invasion with haematogenic dissemination, tissue infarction and necrosis. The most often affected site is the lung. A laryngeal localization is exceptional and usually results from dissemination from a lower airways portal of entry. Diagnosis is difficult: cultures are only positive in 50 per cent of cases, while in 60 per cent of cases the characteristic histological features reminiscent of sprigs of mistletoe are only found on postmortem examination. In view of the high morbidity and mortality in acquired immunodeficiency syndrome (AIDS) sufferers, this condition must be treated early and aggressively. Treatment is based essentially on amphotericin B and itraconazole.

An unusual localisation of Kaposi's sarcoma: the external auditory canal.

The epidemic form of Kaposi's sarcoma is associated with human immunodeficiency virus infection. Cutaneous and mucosal manifestations are frequently reported in the ENT sphere, mostly involving the oral cavity. The external and middle ear are only rarely concerned with only one case of a mastoid lesion without extension to the external auditory canal (EAC) being reported to this day. The present article describes the first case of involvement of the EAC with extension to adjacent structures. This patient presented other Kaposi lesions and had been treated by systemic hormonal therapy. Thereafter local injection of a cytotoxic agent was given without effect. Finally, radiotherapy resulted in a 50% regression of the tumour mass. The epidemiologic factors and therapeutic modalities with their results are described.