Dual blockade of IL-4 and IL-13 with dupilumab ameliorates sensorineural olfactory dysfunction in mice with eosinophilic sinonasal inflammation.

BACKGROUND: Dupilumab, an antibody that binds IL-4Rα and inhibits IL-4 and IL-13 signals, has demonstrated efficacy in chronic rhinosinusitis with nasal polyps (CRSwNP) primarily characterized by type 2 inflammation. Current evidence suggests that the rate of improvement in olfactory dysfunction with dupilumab exceeds that of nasal polyp reduction, yet the underlying mechanism remains undisclosed. We hypothesize that dupilumab may initially ameliorate sensorineural olfactory dysfunction. METHODOLOGY: Male BALB/c mice were intranasally administered ovalbumin and Aspergillus protease for 12 weeks to induce eosinophilic sinonasal inflammation. Dupilumab treatment was also administered. The mice underwent histological assessment, olfactory behavioural test, and gene expression profiling to identify neuroinflammatory markers within the olfactory bulb. RESULTS: Dupilumab treatment resulted in a reduction in the number of mucosal protruding lesions, as well as decreased infiltration of eosinophils and neutrophils, along with a decrease in olfactory sensory neuron injury. Furthermore, there was a downregulation in the mRNA expression related to microglia activation and neuroinflammation in the olfactory bulb. CONCLUSIONS: Dupilumab improves the sensorineural pattern of olfactory dysfunction in mice, potentially explaining why olfaction improves more rapidly than polyp reduction in patients with CRSwNP.

Klebsiella pneumoniae pharyngitis mimicking malignancy: a diagnostic dilemma.

Acute pharyngitis is a common disease. However, acute pharyngitis caused by Klebsiella pneumoniae with a gross appearance mimicking hypopharyngeal malignancy has never previously been reported. We report the case of a 57-year-old man with a right hypopharyngeal tumor which was disclosed by fiberoptic laryngoscopy and computed tomography scan. However, both the frozen and final pathologies showed no evidence of malignant cells, and a bacterial culture revealed the growth of K. pneumoniae. The hypopharyngeal lesion completely regressed after 2 weeks of antibiotic treatment. Clinicians should perform biopsy along with tissue culture for tumor-like lesions because infectious agents can lead to lesions with malignancy-like appearance.

Critical airway induced by formalin injection: case report.

BACKGROUND: Formalin is a saturated aqueous solution comprising 37-40 per cent formaldehyde. It is often used in histopathology laboratories as a tissue preservative. The ingestion or injection of formalin has an immediate, powerful and destructive impact on humans. This paper reports a case of formalin injection and reviews the relevant world literature. CASE REPORT: A 36-year-old male attempted suicide by injecting formalin into the right side of his neck, resulting in a critical airway situation. An endotracheal tube was inserted and a tracheostomy was then performed to secure his airway. After receiving medical treatment, including antibiotics and N-acetyl cysteine, the status of the patient's airway improved. CONCLUSION: When examining patients who have injected substances into their neck, the possibility of deep neck inflammation with airway compromise should be considered. Immediate management, which should include establishment of a definitive airway and prophylactic infection control, is crucial.