[A 4-year-old girl with a recurrent infection in the neck: a familiar picture with a rare cause]. / Een 4-jarig meisje met recidiverende halsinfecties.

BACKGROUND: Infections of the neck are frequently seen in young children and are usually harmless and transient. In the case of atypical symptoms, however, it is important to be alert to the possibility of less common causes requiring specific treatment. CASE DESCRIPTION: A 4-year-old girl was seen in the outpatient clinic with a recurrent, inflamed swelling in the neck. The swelling persisted despite repeated incision and drainage. Further investigation with MRI revealed a primary branchial cleft fistula, Work type 2. The epithelialized cartilaginous fistula tract ran from the external auditory canal to the neck, very close to the facial nerve, but could be surgically removed without damage to the nerve. CONCLUSION: In a child with a recurrent swelling or abscess in the neck, with or without a fistula, an extensive differential diagnosis is required including branchial cleft fistula.

Eye for an eye: near-fatal outcome of fungal infection in a young, diabetic girl.

In this report, we describe the case of a young, diabetic girl with ketoacidosis who suffered sudden loss of vision of the right eye. The loss of vision was caused by an invasive rhino-orbital-cerebral fungal infection (mucormycosis) with extensive periorbital thrombosis. Despite maximal antifungal and surgical treatment (including exenteration of the right orbit), the clinical situation deteriorated. It was only after overcoming the difficulties of managing her hyperglycaemia that the patient's condition stabilised and her life was saved. Another factor contributing to this girls' survival was the swift diagnosis of mucormycosis, which was made soon after the onset of symptoms. Because of this, treatment could be started almost immediately.