RESUMEN
Perforations of the nasal septum have many etiologies and occasionally result from intranasal medicated spray use. This case report describes a perforation related to the use of desmopressin nasal spray, which has not been previously reported in the literature. Clinical considerations presented in this article include appropriate technique of nasal spray application, appropriate monitoring of patients on intranasal sprays, and indications for evaluation by an otolaryngologist. Septal perforation treatment success is improved with an early diagnosis.
Asunto(s)
Perforación del Tabique Nasal , Humanos , Perforación del Tabique Nasal/inducido químicamente , Rociadores Nasales , Desamino Arginina Vasopresina/efectos adversos , Tabique Nasal , Resultado del TratamientoRESUMEN
Nasal septal perforation caused by bevacizumab is rarely reported in other cancers such as ovarian cancer and breast cancer, but it has not been reported in cervical cancer. A 48-year-old woman with a medical history of chronic allergic rhinitis was diagnosed stage 4B (T2bN1M0) cervical cancer and paclitaxel and carboplatin along with bevacizumab (triweekly) were administered. After eight courses of chemotherapy, nasal septal perforation was noted. The possibility of nasal septal perforation by bevacizumab was considered by excluding other causes. We report the first case of nasal septal perforation caused by bevacizumab for advanced cervical cancer.
Asunto(s)
Perforación del Tabique Nasal , Neoplasias del Cuello Uterino , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica , Bevacizumab/efectos adversos , Carboplatino , Femenino , Humanos , Persona de Mediana Edad , Perforación del Tabique Nasal/inducido químicamente , Paclitaxel , Neoplasias del Cuello Uterino/tratamiento farmacológicoRESUMEN
BACKGROUND: Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients. METHODS: A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out. RESULTS: Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion. CONCLUSION: As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.
Asunto(s)
Cocaína/efectos adversos , Inhibidores de Captación de Dopamina/efectos adversos , Levamisol/efectos adversos , Antagonistas Nicotínicos/efectos adversos , Enfermedades Nasales/inducido químicamente , Trastornos Relacionados con Sustancias/complicaciones , Vasculitis/inducido químicamente , Adulto , Trastornos Relacionados con Cocaína/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perforación del Tabique Nasal/inducido químicamente , Estudios RetrospectivosRESUMEN
Abstract: We report a 42-year-old cocaine addicted female patient referred for evaluation of hard palate ulceration resulting in oro-sinus communication with difficulties in swallowing and phonation, an rhino-sinusitis. Acrylic and removable silicone prosthesis was prescribed to relieve severe functional disorders. It is essential that the patient permanently abandons cocaine use to perform surgical reconstruction.
Asunto(s)
Humanos , Femenino , Adulto , Fístula Oral/diagnóstico , Fístula Oral/inducido químicamente , Trastornos Relacionados con Cocaína/complicaciones , Paladar Duro/efectos de los fármacos , Perforación del Tabique Nasal/diagnóstico , Perforación del Tabique Nasal/inducido químicamente , Obturadores Palatinos , Tomografía Computarizada por Rayos X , Fístula Oral/terapia , Cocaína/efectos adversos , Paladar Duro/diagnóstico por imagen , Perforación del Tabique Nasal/terapiaRESUMEN
Nasal septum perforation in patients with cancer receiving systemic therapy is rare, and its association with bevacizumab use has described recently in the literature. Here, we report the case of a 34-year-old woman with hormone-sensitive, HER-2/neu negative, metastatic breast cancer who develope a nasal septum perforation during the treatment with paclitaxel and bevacizumab.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Perforación del Tabique Nasal/diagnóstico , Adulto , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/efectos adversos , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Bevacizumab/administración & dosificación , Bevacizumab/efectos adversos , Neoplasias de la Mama/patología , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Pulmonares/secundario , Perforación del Tabique Nasal/inducido químicamente , Metástasis de la Neoplasia , Paclitaxel/administración & dosificación , Paclitaxel/efectos adversosRESUMEN
IMPORTANCE: A case of nasal septal perforation secondary to systemic bevacizumab therapy for ovarian cancer is reported. Bevacizumab is a vascular endothelial growth factor A (VEGF-A) inhibitor that is becoming more widely utilized in the oncologic community. There is only one prior report of septal perforation secondary to bevacizumab in the Otolaryngology specific literature. The purpose of this report is: 1) to raise awareness and discuss the literature surrounding the sinonasal complications of bevacizumab and 2) provide workup and treatment recommendations based on the sum of the available literature. OBSERVATIONS: We review the clinical record of a 59year old patient who presented with an anterior septal perforation while taking bevacizumab therapy for ovarian cancer. She had mild symptoms. Her oncologist held bevacizumab and topical moisture therapy was started. After several weeks, the perforation remained stable and bevacizumab was restarted for her ovarian cancer. CONCLUSION AND RELEVANCE: Bevacizumab is associated with both septal perforation and more widespread sinonasal toxicity. These lesions tend to produce only mild symptoms and can usually be managed conservatively. The decision to hold bevacizumab therapy should be made in conjunction with the patient and medical oncologist. Otolaryngologists should be aware of the toxicity from this increasingly common oncologic therapy.
Asunto(s)
Bevacizumab/efectos adversos , Perforación del Tabique Nasal/inducido químicamente , Tabique Nasal/diagnóstico por imagen , Administración Intranasal , Inhibidores de la Angiogénesis/efectos adversos , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Femenino , Estudios de Seguimiento , Geles/administración & dosificación , Humanos , Persona de Mediana Edad , Perforación del Tabique Nasal/diagnóstico , Perforación del Tabique Nasal/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Receptores de Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
We report a 42-year-old cocaine addicted female patient referred for evaluation of hard palate ulceration resulting in oro-sinus communication with difficulties in swallowing and phonation, an rhino-sinusitis. Acrylic and removable silicone prosthesis was prescribed to relieve severe functional disorders. It is essential that the patient permanently abandons cocaine use to perform surgical reconstruction.
Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Perforación del Tabique Nasal/inducido químicamente , Perforación del Tabique Nasal/diagnóstico , Fístula Oral/inducido químicamente , Fístula Oral/diagnóstico , Paladar Duro/efectos de los fármacos , Adulto , Cocaína/efectos adversos , Femenino , Humanos , Perforación del Tabique Nasal/terapia , Fístula Oral/terapia , Obturadores Palatinos , Paladar Duro/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Concern for illicit and restricted drug use in otolaryngology is similar to other surgical specialties with a few notable exceptions. Many illicit drugs are consumed transnasally. Repeated nasal exposure to stimulants or narcotics can cause local tissue destruction that can present as chronic rhinosinusitis or nasoseptal perforation. Further, the Food and Drug Administration has taken a stance against codeine for pediatric patients undergoing adenotonsillectomy. They have identified an increased risk of death postoperatively with these medications. Because codeine has been the most commonly prescribed narcotic, this has shifted the standard practice.
Asunto(s)
Narcóticos/efectos adversos , Perforación del Tabique Nasal/inducido químicamente , Nariz/efectos de los fármacos , Osteonecrosis/inducido químicamente , Trastornos Relacionados con Sustancias/diagnóstico , Analgésicos Opioides/efectos adversos , Codeína/efectos adversos , Sobredosis de Droga/diagnóstico , Humanos , Drogas Ilícitas/toxicidad , Nariz/patología , Osteonecrosis/diagnóstico , Otolaringología , Trastornos Relacionados con Sustancias/complicacionesAsunto(s)
Analgésicos/efectos adversos , Ketamina/efectos adversos , Perforación del Tabique Nasal/inducido químicamente , Trastornos Relacionados con Sustancias/complicaciones , Administración Intranasal , Analgésicos/administración & dosificación , Epistaxis/inducido químicamente , Humanos , Ketamina/administración & dosificación , Masculino , Trastornos Urinarios/inducido químicamente , Adulto JovenRESUMEN
A 58-year-old woman with a 31-year history of Hailey-Hailey (HH) disease that was refractory to treatment with mycophenolate mofetil, cyclosporine, dapsone, sulfasalazine, topical/oral antibiotics, and topical/oral steroids presented for alternative treatment options. Active erythematous, malodorous, eroded, and crusted plaques were present in the axillae, inframammary region, groin, and back (Figure 1). The patient had an undulant course, with acute exacerbations and partial remissions. During a 3-year period, she was prescribed oral methotrexate at a dose of 10 mg to 15 mg per week with daily oral folic acid (1 mg) supplementation, except on the day she took methotrexate. Oral clarithromycin and prednisone were also used intermittently for antibacterial and anti-inflammatory effects.
Asunto(s)
Fármacos Dermatológicos/efectos adversos , Metotrexato/efectos adversos , Perforación del Tabique Nasal/inducido químicamente , Pénfigo Familiar Benigno/tratamiento farmacológico , Administración Oral , Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Prednisona/uso terapéuticoRESUMEN
BACKGROUND: The nasal cavity is a vulnerable zone which may be damaged by vascular disorders. We systematically assessed the frequency and severity of nasal cavity alterations during bevacizumab treatment, to determine its clinical relevance and factors contributing to its onset. PATIENTS AND METHODS: We conducted a hospital-based cohort study in 47 consecutive patients with advanced cancers who were on treatment with chemotherapy and bevacizumab at different doses. All patients underwent otolaryngology (ENT) examination at the time of study initiation. RESULTS: The mean number of cycles at first ENT examination was 16 (standard deviation = 14). A total of 45 patients (96%) showed nose mucosal lesions, of whom 30% had erosions and 62% had grade 1 - 2 epistaxis. One patient had septal perforation. Grades 1 - 4 sinus disorders were noted in 60%. There was a significant trend to a higher risk of grade ≥ 2 nasal events for bevacizumab doses > 7.5 mg/kg, concomitant taxane use and digital nasal self-manipulation. CONCLUSIONS: We found a high incidence of nasal cavity lesions in patients receiving bevacizumab, with evidence for a dose-related effect. Most cases were low grade and manageable without drug interruption, but severe toxicity may rarely occur. Oncologists should be aware of this unusual event.
Asunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Epistaxis/inducido químicamente , Cavidad Nasal/efectos de los fármacos , Mucosa Nasal/efectos de los fármacos , Perforación del Tabique Nasal/inducido químicamente , Anciano , Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Bevacizumab , Relación Dosis-Respuesta a Droga , Epistaxis/diagnóstico , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Cavidad Nasal/patología , Mucosa Nasal/patología , Perforación del Tabique Nasal/diagnóstico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
INTRODUCTION: Neovascularisation is a hallmark of cancer. Vascular endothelial growth factor (VEGF) is directly involved in the regulation of this tumoural neoangiogenesis, especially in lung cancer. Bevacizumab is a humanized monoclonal antibody targeting VEGF that is commonly used in thoracic oncology. Among the side effects, perforation of the nasal septum is rare. CASE REPORT: We report the case of a 50-year-old woman with adenocarcinoma of the right upper lobe, immediately metastatic, treated with five cycles of chemotherapy (cisplatin, gemcitabine, bevacizumab). She developed a perforation of the nasal septum after the third injection of bevacizumab given as monotherapy during the maintenance phase. CONCLUSIONS: This is, to our knowledge, the first description of this complication in the course of treatment of bronchial carcinoma. Its management is purely symptomatic. The action to be taken in using bevacizumab is not fully codified.
Asunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Perforación del Tabique Nasal/inducido químicamente , Adenocarcinoma/complicaciones , Adenocarcinoma/tratamiento farmacológico , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab , Cisplatino/administración & dosificación , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Clorhidrato de Erlotinib , Resultado Fatal , Femenino , Glutamatos/uso terapéutico , Guanina/análogos & derivados , Guanina/uso terapéutico , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Quimioterapia de Mantención , Persona de Mediana Edad , Proteínas de Neoplasias/antagonistas & inhibidores , Pemetrexed , Quinazolinas/uso terapéutico , Insuficiencia Respiratoria/etiología , Terapia Recuperativa , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , GemcitabinaAsunto(s)
Absceso Encefálico/diagnóstico , Meningitis por Escherichia coli/etiología , Enfermedades de la Hipófisis/diagnóstico , Enfermedad Aguda , Administración por Inhalación , Adulto , Asma/complicaciones , Absceso Encefálico/complicaciones , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/cirugía , Ceftriaxona/uso terapéutico , Trastornos Relacionados con Cocaína/complicaciones , Diagnóstico Diferencial , Drenaje , Quimioterapia Combinada , Femenino , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética , Meningitis por Escherichia coli/tratamiento farmacológico , Meningitis por Escherichia coli/cirugía , Perforación del Tabique Nasal/inducido químicamente , Perforación del Tabique Nasal/complicaciones , Fotofobia/etiología , Enfermedades de la Hipófisis/complicaciones , Enfermedades de la Hipófisis/tratamiento farmacológico , Enfermedades de la Hipófisis/cirugía , Neoplasias Hipofisarias/diagnóstico , Vancomicina/uso terapéuticoRESUMEN
To date, the published literature describes 18 reports of nasal septal perforation in cancer patients with the administration of bevacizumab. This complication was detected during post-marketing surveillance of bevacizumab. How should patients who develop this complication be managed? This discussion summarizes suggestions for management of bevacizumab-associated nasal septal perforation and, as relevant to healthcare providers, discusses some of the practical aspects of post-marketing pharmacovigilance.