Amyloidosis Localized to the Sinonasal Tract: From the Diagnosis to Management of Disease.

Amyloidosis is a mainly systemic rare disease and its localized presentation is even less frequent. Systemic forms are often associated with other conditions or entities (such as neoplasms), and a correct etiological study of patients with this disease is essential. A localized presentation has a better prognosis compared to systemic forms, which underlines the importance of a correct diagnosis. Primary localized amyloidosis in the head and neck region is a rare entity. Primary amyloidosis localized to the sinonasal tract is extremely rare. Although uncommon, case reports have been increasing in the face of new endoscopic and imaging techniques, and the report of these cases is crucial for a better characterization of this entity. Symptoms may include epistaxis, nasal obstruction, facial deformity, and vision changes. A 72-year-old female with a history of frequent nasal congestion with two years' duration showed no improvement following symptom management. She was referred for nasal endoscopy and biopsy, thereby confirming the diagnosis of amyloidosis. Further diagnostic testing did not show evidence of systemic disease. This case report was previously presented as a poster presentation at the 19th European Congress of Internal Medicine in March 2021.

Lithium Intoxication in an Elderly Woman.

Acute confusional state or delirium in the elderly frequently requires a lengthy differential diagnosis in the emergency room (ER) to determine the factors of its multiple causes. Iatrogeny can be one of the causes, especially in elderly people with polypharmacy. We present a case of a 77-year-old female, independent in activities of daily living, with no cognitive impairment and a history of hypertension, dyslipidemia, and manic-depressive disorder. She arrived at the ER with diarrhea, vomiting, and myalgias. A blood test revealed an acute kidney injury. The patient was discharged with the diagnosis of acute gastroenteritis and prerenal acute kidney injury. The patient returned to the ER two days later due to worsening symptoms, including spatial and temporary disorientation and a marked prostration. The attending physician recommended a lithium blood level test due to the patient's history and the outpatient's psychiatric medication. The tests revealed a value of 2.18 mmol/L (toxic levels: >2.0 mmol/L). Support measures were initiated with diuresis control and vigorous hydration, with subsequent clinical and biochemical improvement (lithium blood levels reduced to 0.97 mmol/L). Lithium toxicity causes acute nausea, vomiting, diarrhea, and neurological symptoms that have a slower onset and correlate with chronic toxicity. A declining renal function and reduced volume of distribution (due to increased body fat mass and decreased total body water) contribute to more significant pharmacological toxicity in the elderly. In this case, dehydration triggered by diarrhea and vomiting may have been a cause or a consequence. Reviewing chronic medication and a detailed investigation of all etiological causes was essential for the patient's rehabilitation, avoiding possible irreversible neurological damage.