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We describe three cases of chronic dental sepsis presenting with facial suppuration (dentocutaneous sinus). Misdiagnosis may lead to unnecessary morbidity. Inappropriate hospital referral wastes resources.
Acute suppurative thyroiditis (AST) is a rare disorder. The rarity of AST is a result of the resistance of the thyroid gland to local infection. Thyroid function tests are usually normal in AST. In a review of the literature from 1966 to 1995, only three cases of AST associated with thyrotoxicosis have been convincingly demonstrated. The thyrotoxicosis in these cases was caused by diffuse inflammation of the thyroid gland and to the disruption of follicles with the release of pre-formed thyroid hormone into the circulation. Thus, the thyrotoxicosis in these cases was transient. With successful therapy, nearly all patients showed complete recovery of thyroid function within two to three months. The patient in the case here was a diabetic woman with Graves' disease in whom thyrotoxicosis occurred after Klebsiella pneumoniae thyroiditis, with relapse nine months after discharge. Thus, the patient's thyrotoxicosis might not have been caused simply from thyroid tissue destruction by AST, but also as a result of enhancing autoimmune activity. No previous case has ever been reported in the English literature. In diabetics, the impairment of chemotaxis and phagocytosis has been noted. Therefore, diabetes mellitus (DM) might have been the precipitating factor for this patient's acquiring this unusual infection. Thyrotoxicosis and AST will increase insulin requirements and thus aggravate diabetes. In addition, poor control of blood sugar will enhance the severity of AST.
259 patients with chronic suppurative otitis media were bacteriologically assessed. 12 bacterial strains were isolated in 196 of the cases. The most common species present was Staphylococcus - 77 (39%) cases, followed by Proteus vulgaris isolated in 36 (18%) cases, and Pseudomonas aeruginosa in 33 (17%) cases. The flora in 25 cases (18%) yielded two bacterial strains with identical oxygen demands, and a mixture of Staphylococcus and Streptococcus in 32%. In 60.6% of cases the flora was sensitive to ototoxic antibiotics (gentamycin, kanamycin and neomycin), especially to gentamycin - 29.9%. The highest sensitivity of the flora to non-ototoxic antibiotics was to chlorocid (in 25.5% of the cases). Topical and systemic treatment were administered based on antibiogram and the inflammation and the otorrhea were controlled in 91.4% of the cases. No or little effect was found in the patients with cholesteatoma (8.6%). A conclusion was made that the monoflora was the commonest in the ear effusion (87%), comprising facultative anaerobes, present in 63.8%, anaerobes in 18.8%, and aerobes, mainly Pseudomonas aeruginosa, in 17.4%. The combined (topical and systemic) treatment based on antibiogram is effective in the preoperative management of the inflammation.
We have found a series of 14 cases of chronic suppuration of the breast in 10 years in the Surgical and Gynaecological Clinic of the Salpêtrière Hospital. The symptomatology at the outset is usually innocuous, showing itself as a tumour that appears either gradually or suddenly. Diagnosis is not difficult and is usually solved by tapping the tumour. The progress of these lesions to become chronic with the formation of fistulae is the main risk, and the incident is not negligible. Thus the true problem is to find the correct therapy so as to avoid this possible unfavourable outcome.
OBJECTIVE: To propose a practical and reasonable classification of chronic suppurative parotitis (CSP) on the basis of the various entities. MATERIAL AND METHODS: Clinical, laboratory, sialographic, scintigraphic, histopathologic (including ultrastructural) study of recurrent parotid swellings (RPS) was performed in 291 patients over a 10-year period. RESULTS: It is suggested that CSP should be classified into recurrent parotitis in childhood (RPC), recurrent parotitis in adults (RPA), chronic obstructive parotitis (COP) and should be differentiated from other subdivisions including subclinical Sjögren's syndrome (SCSS), chronic parotid swelling of Sjögren's syndrome and sialadenosis with retrograde infection. RPA is a continuation of recurrent parotid swelling from childhood (RPC) to adulthood. Remission can take place spontaneously in RPC and RPA so that self-conservative therapy is mainly used for reducing the parotid swellings. COP is recurrent parotid swellings and/or purulent discharge resulting from various obstructive factors. Mild COP can recover completely with the use of conservative methods, severe COP is often resistant to conservative treatment and should be treated with surgical modality or injection of methyl violet into the diseased gland. Treatment with methyl violet is considered as a convenient and practical method with a definite effect. SCSS is an autoimmune disease and should be treated as systemic disease. CONCLUSIONS: Because there exists confusion in the nomenclature of RPS this revised classification is based on the various entities and can be used as a guide in the diagnosis and treatment of RPS.
We report an uncommon case of acute suppurative thyroiditis arising from a piriform sinus fistula. Postcontrast computed tomography (CT) revealed an anterior neck abscess extending from the left piriform sinus inferiorly towards the left lobe of the thyroid gland, in addition to bilateral cervical lymphadenopathy.
BACKGROUND: Non-typloid salmonella can cause septicemia and extradigestive disorders in immunodepressed adults. These frequent diseases can be life-threatening. CASE REPORT: A 76-year-old woman was treated with corticosteroid therapy for 1 year for suppurated thrombophlebitis of the right greater saphenous vein. Weight loss, fever at 41 degrees C and Salmonella enterididis isolated from blood cultures and skin samples led to the diagnosis of septicemia with multiple septic foyers including the venous endothelium and surrounding soft tissue. DISCUSSION: In Western countries, there has been an uprise in the frequency of low-grade salmonella infections by food poisoning usually causing acute diarrhea. S. enterididis can also cause severe infectious syndromes with multiple septic localizations, main in patients with a compromised immune reaction. In our cases, Salmonella enteritidis septecemia was revealed by an unusual situation. In the literature, inaugural signs usually involve the heart or arteries, but our patient had isolated foyers involving the superficial venous network. This is exceptional especially since there was no iatrogenic venous catheter insult. For our patient, favoring factors were the long-term corticosteroid therapy and altered venous network. The portal of entry could not be clearly identified but the discovery of a sigmoid diverticulosis would be an argument favoring a digestive origin. Medical and surgical management with resection of the necrosed tissues and two adapted antibiotics in a long-term regimen led to a successful outcome.
We conducted a test of the efficacy of ciprofloxacin eardrops in 80 patients (95 ears) with otorrhea due to chronic suppurative otitis media in two treatment settings. One group (n = 40; 47 ears) received daily ciprofloxacin therapy plus aspiration in the clinic. The other group (n = 40; 48 ears) self-administered ciprofloxacin at home. Overall, otorrhea resolved in 88% of all ears within 12 days of the initiation of treatment. The clinic-treated patients tended to respond more rapidly than did the self-treated patients, but there was no statistically significant difference in success rates between the two groups. Side effects were negligible. We conclude that empiric topical ciprofloxacin therapy is an effective, safe and relatively inexpensive treatment for otorrhea in patients with chronic otitis media.
Acute suppurative thyroiditis is very rare and often related to congenital abnormalities of the branchial pouches or immunodeficiency. A case of acute thyroiditis due to fistula of the left pyriform sinus in a young man with no relevant history is reported. We review the embryology, diagnosis, and treatment of this rare entity.
Resting common bile duct pressure was measured in three groups of patients: group 1, 53 patients with gallstones but without common duct stones; group 2, 35 patients with common bile duct stones unaccompanied by cholangitis; and group 3, 36 patients with common duct stones and acute suppurative cholangitis. A significantly higher pressure in the common bile duct was documented in patients with cholangitis when compared with the other two groups. Twenty-four patients with cholangitis had common duct pressure values above 20 cm H2O, the maximal values of normal. Additionally, patients with cholangitis with pressure values over 30 cm H2O (nine patients) showed absence of green bile in the extrahepatic biliary tract, suggesting cessation of bile excretion into biliary duct. In all these cases, an impacted stone at the distal end of the common bile duct was documented.
Three children with suppurative arthritis and osteomyelitis are described to emphasise that delayed or incorrect diagnosis may lead to serious cardiopulmonary complications. In two patients, bilateral bronchopneumonia developed with pneumatocoeles, pneumothorax and empyema. The other had cardiac failure from septic pericarditis. In one case, disarticulation of the knee was needed as a life-saving measure, and the other leg developed an infected pseudarthrosis of the tibia. The causative organism in each case was staphylococcus aureus and no evidence of immunodeficiency was demonstrated.
The histologic variety and transformation in cutaneous cryptococcosis with acute lymphocytic leukemia before antifungal treatment and after the start of treatment were studied by the light and electron microscopic examinations. The initial cutaneous lesions before treatment revealed gelatinous tissue reactions, and Cryptococcus neoformans (serotype A) were isolated from the skin biopsy specimen and blood. However, later recurrent cutaneous lesions receiving antifungal treatment revealed suppurative granulomatous tissue reactions, and fungal cultures of the skin biopsy specimen changed to negative even though numerous yeasts stained with PAS were observed in skin lesions. Moreover, in the later lesion a few giant cells contained asteroid bodies without central spores. Ultrastructure of the later cutaneous lesions is presented.
A surgical case of leiomyosarcoma arising from the ascending colon, presenting as acute suppurative peritonitis, is herein described. A 70-year-old woman complaining of lower abdominal pain presented to our clinic on October 12, 1994. She was admitted with a tentative diagnosis of peritonitis. At emergency laparatomy, purulent intraabdominal fluid was present, and a fist-sized mass was seen in the ascending colon just proximal to the hepatic flexure. A right hemicolectomy was thus performed based on a diagnosis of perforating colon cancer. The histologic findings were consistent with leiomyosarcoma with abscess formation in and around the tumor. Five mitotic figures per field were observed at 10x magnification. Immunohistochemical studies revealed immunoreactivity for alpha-smooth muscle antigen (alpha-SMA), vimentin, and desmin. After reviewing the clinicopathologic characteristics of colon leiomyosarcoma as described in 78 Japanese cases and 70 cases from the foreign literature, we thus propose that colon leiomyosarcoma frequently arises from the transverse colon. In addition, our case also represents the only reported case in Japan in which an adult patient underwent a successful operation for perforated leiomyosarcoma of the colon.
A 73-year-old man with a preoperative diagnosis of cholangitis underwent a laparotomy, which revealed a necrotized gallbladder and dilated common bile duct, both filled with foul-smelling clotted blood. We could not find the cause of hemobilia at this time. On postoperative day (POD) 11, an exsanguinating hemorrhage suddenly began pouring from the T-tube, suggesting the possibility of a ruptured gastroduodenal artery branch aneurysm into the biliary system. Immediate angiography confirmed multiple aneurysms of the gastroduodenal artery. Embolization was done and there was no further bleeding from the T-tube; however, the patient's condition was too critical for recovery and he died on POD 17. At autopsy, we found multiple aneurysms in the gastroduodenal artery. The posterior superior pancreaticoduodenal artery, diverging from one of the aneurysms of the gastroduodenal artery, formed another tiny aneurysm subjacent to the common bile duct wall. Rupture of this aneurysm into the biliary system caused fatal acute obstructive suppurative cholangitis.
Hemophilus aphrophilus is an uncommon pathogen in man. It has rarely been reported as a cause of meningitis, exclusively in boys three years or younger. Osteomyelitis due to this organism is also rare. H. aphrophilus was responsible for meningitis, probable thoracic empyema, and ultimately vertebral osteomyelitis and suppurative psoas abscess formation in a woman following metrizamide myelography. The patient responded well to antibiotic treatment and surgical drainage. The organism was sensitive not only to chloramphenicol but also to newer cephalosporin antibiotics.
In 2 patients presenting with fever of undeterminated origin, cryptogenic suppurative pylethrombosis caused by Bacteroides fragilis was diagnosed. Combined antibiotic and anticoagulant therapy resulted in recanalization of the thrombosed vessels. The role of ultrasonography and computed tomography scan in the diagnosis and follow-up of this rare condition is discussed.
Actinobacillus actinomycetemcomitans was isolated on culture of an aspirate from a 36-year-old woman with unilateral cervical adenitis. We believe this to be the first report of A. actinomycetemcomitans causing suppurative cervical adenitis.
The aerobic and anaerobic microbiology of 38 children from Surabaya, Indonesia, who suffered from chronic suppurative otitis media (CSOM) was studied using strict microbiological methodology. A total of 106 isolates (49 anaerobic and 57 aerobic) were recovered. Aerobic organisms alone were isolated from 11 (29%), anaerobic bacteria only in 4 (11%) and mixed aerobic and anaerobic flora were present in 23 (60%). The predominant organisms were Peptostreptococcus sp., Prevotella sp., Bacteroides sp., Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Fusobacterium sp. Thirty-nine beta-lactamase-producing bacteria were recovered from 22 (58%) patients. These findings demonstrate the role of penicillin resistant aerobic and anaerobic bacteria in the polymicrobial etiology of CSOM in children from Indonesia. Judicious use of antimicrobial therapy may prevent the development of antimicrobial resistance.