Giant cellulitis-like Sweet syndrome mimicking cellulitis: a case report.

BACKGROUND: Sweet syndrome (acute febrile neutrophilic dermatosis) is an uncommon inflammatory disorder characterized by the abrupt appearance of painful, edematous, and erythematous papules, plaques, or nodules on the skin. There are various subtypes, such as classical, drug-induced, malignancy-associated, and the less common variant giant cellulitis-like Sweet syndrome. This case is unique due to its presentation of the giant cellulitis-like variant of Sweet syndrome in a patient from Ethiopia. The unusual distribution of the skin lesions and the initial lack of response to antibiotics make this case particularly noteworthy. It underscores the importance of considering Sweet syndrome in differential diagnoses when faced with atypical skin manifestations and ineffective antibiotic treatment. This contribution adds valuable insights to the scientific literature by highlighting the need for heightened awareness of this rare variant and improving diagnostic accuracy in similar clinical scenarios. CASE PRESENTATION: A 60-year-old Ethiopian male patient who presented to the accident and emergency department with a 5-day history of fever, chills, sweating, and rigor accompanied by a reddish skin color change around the anterolateral region of the right chest wall. On physical examination, there were erythematous, indurated tender plaques with ill-defined borders over the right antero- and posterolateral chest wall with extension to the lateral part of the right neck and medial aspect of the right arm. Subsequently, the patient was started on antibiotics, but there was a suboptimal response. Skin biopsy revealed features suggestive of giant cellulitis-like Sweet syndrome. He was then started on steroids, which significantly improved his symptoms. CONCLUSION: A cautious stance is essential when identifying Sweet syndrome in individuals displaying erythematous plaque-like skin lesions in atypical areas of the body with uneven distribution. Such presentation may signal Sweet syndrome rather than a common infection. If conventional treatments, such as antibiotics, fail to resolve symptoms, consider Sweet syndrome as a potential diagnosis. This approach ensures timely and appropriate treatment, preventing treatment delay and misdiagnosis.

Complicated Mucocutaneous Leishmaniasis With Superimposed Cellulitis in an Immunocompromised Patient: A Case Report.

Leishmaniasis is a common protozoal infection that could be cutaneous (CL), mucocutaneous (MCL), or visceral. CL, which is the most common form, is typically localized. Therefore, it becomes more difficult to diagnose it when presenting with diffuse lesions. In this case, a 54-year-old man presented with skin lesions involving his trunk, extremities, and face, including the nasal mucosa. His past medical history was remarkable for MCL with synovial leishmaniasis, systemic lupus erythematosus (SLE), and non-Hodgkin's lymphoma (NHL). Skin biopsies showed intracytoplasmic leishmania amastigotes; polymerase chain reaction (PCR) was positive for leishmania DNA; and a culture from purulent skin lesions grew Pseudomonas aeruginosa. So, MCL with superimposed cellulitis was diagnosed, and the patient was treated with intravenous liposomal amphotericin B and ceftazidime. Leishmaniasis is an infection that has accurate diagnostic tests and various treatment options. However, the difficulty is in being able to suspect it clinically, as it can mimic a wide range of diseases with cutaneous involvement. Therefore, visual awareness of the spectrum of disease presentations is arguably the most challenging and important skill to acquire in the diagnosis and management of CL. This case represents a rare form of MCL.

Prompt diagnosis and treatment of peri-orbital necrotising fasciitis caused by group A ß-haemolytic Streptococcus (GAS): a case report.

BACKGROUND: Necrotising fasciitis is a devastating infection characterised by rapidly progressing necrotising infection of the superficial fascia with secondary necrosis of the overlying skin. AIMS: To describe the pathophysiology, differential diagnosis, and outcome in a rare case of periorbital necrotising fasciitis caused by group A ß-haemolytic Streptococcus. METHODS: A 60-year-old female with insulin-dependent diabetes presented with pyrexia and bilateral peri-orbital swelling, progressing to left periorbital necrotising fasciitis. It was caused by dual infection with group A ß-haemolytic Streptococcus and Herpes Simplex Virus 1. RESULTS: A combination of intravenous antibiotics and surgical debridement and subsequent skin grafting resulted in a beneficial outcome in our patient. CONCLUSIONS: Differentiating cellulitis and necrotising fasciitis can be difficult when presenting signs and symptoms are non-specific. If not treated quickly with antibiotics and debridement of the infected tissue, the patient may develop septic shock within hours.

Rehabilitation Strategies for Post-fasciotomy Recovery in Acute Spreading Cellulitis: A Case Report.

Cellulitis is a skin condition that affects both the dermis and the subcutaneous fat. Acute compartment syndrome has been associated with streptococcal infection. The present case highlights the role of physiotherapy in rehabilitating a patient suffering from compartment syndrome due to cellulitis. A 45-year-old female complained of swelling over the left forearm for five days. After being referred to the surgery department, she underwent clinical examinations, indicating cellulitis. As part of the surgical procedure, she had a fasciotomy and split skin grafting. Her pain was assessed using the numerical pain rating scale (NPRS), gradual in onset and progressive in nature, and aggravated on movement. The patient's case demonstrates the importance of following a planned physical therapy treatment regimen to restore functional activity, range of motion (ROM), and muscle strength.

A Case of Persistent Pasteurella multocida Cellulitis Complicated With Large Endocarditis Vegetation.

In the realm of infective endocarditis, a distinct and infrequent player emerges - Pasteurella multocida, an organism more commonly associated with zoonotic infections, now warranting careful consideration in this unique case report. P . multocida is a Gram-negative, facultative anaerobic cocco-bacillus and a common member of the oral bacterial flora of cats and dogs. In humans, it commonly causes skin and wound infections after bites and scratches. Disseminated P . multocida infection seeded into the heart valve is very rare and has only been reported in about one case per year worldwide with only 42 cases found in the literature and only five cases reported to have underlying liver cirrhosis as in our case. This is a case of a 73-year-old female with a past medical history of Child-Pugh B liver cirrhosis secondary to primary biliary cholangitis with portal hypertension, splenomegaly, pancytopenia, severe aortic stenosis, and paroxysmal atrial fibrillation presented to hospital with generalized weakness, fever, and new lower extremity rash 48 hours after last dose of antibiotic. She had recent hospitalization for left lower extremity cellulitis and P. multocida bacteremia and received 14 days of high-dose oral amoxicillin-clavulanate with negative blood culture prior to discharge. She occasionally helps her son to feed his cats and dog whenever he travels. She was readmitted and a repeat blood culture showed P. multocida. Transthoracic echocardiogram showed a 1.9 cm × 1 cm mobile mass attached to the anterior mitral valve leaflet, which was new compared to the prior study obtained during her first admission. She was not a suitable candidate for valve surgery due to her comorbidities. P. multocida was found to be susceptible to penicillin, ampicillin, levofloxacin with negative beta lactamase. Her cellulitis, fever, and bacteremia eventually resolved with intravenous antibiotics. She was ultimately discharged with a two-week course of intravenous ceftriaxone, continued with oral levofloxacin to complete six weeks of total treatment, and followed by long-term penicillin suppression. In this case report, we delve into a rare and intriguing clinical presentation of P . multocida endocarditis. Our patient is the second reported case which showed complication of native mitral valve endocarditis even in the setting of bacteremia resolution. This report sheds light on the challenging diagnosis and management of this uncommon yet clinically significant condition, highlighting the importance of vigilant and prompt intervention in cases of infective endocarditis with atypical causative agents.

Revisiting Fournier's Gangrene: A Contemporary Epidemiological Perspective vs. Perineal Cellulitis.

INTRODUCTION: We conducted a population-based analysis of Fournier's gangrene to compare risk factors and mortality with perineal cellulitis. METHODS: We analyzed National Inpatient Sample data (2016-2020) to identify Fournier's gangrene and perineal cellulitis cases. Demographic, comorbidity, and procedural data were extracted. Logistic models assessed risk factors for Fournier's gangrene diagnosis and mortality. RESULTS: A total of 73,472 cellulitis and 9,326 Fournier's gangrene cases were identified corresponding to 74,905 (range 63,050-79,165) and 9,115 (range 7,925-11,080) median yearly weighted cases, respectively. Fournier's gangrene diagnosis vs cellulitis was positively associated with Native American race (OR 1.46, 95% CI 1.19-1.79), weekend (OR 1.12, 95% CI 1.06-1.18) or December (OR 1.33, 95% CI 1.22-1.44) admissions, diabetes mellitus (OR 2.51, 95% CI 2.38-2.64), and malignancy (OR 2.29, 95% CI 2.07-2.54). Conversely, Hispanic (OR 0.79, 95% CI 0.74-0.85), Asian/Pacific Islander races (OR 0.83, 95% CI 0.69-0.99), and the highest household income quartile (OR 0.84, 95% CI 0.78-0.90) were linked to a reduced likelihood of Fournier's gangrene diagnosis. Elevated mortality risks were observed with female gender (OR 1.33, 95% CI 1.08-1.63), Native American ethnicity (OR 2.29, 95% CI 1.14-4.57), and procedural frequency (OR 1.27, 95% CI 1.24-1.3) among Fournier's gangrene cases. CONCLUSIONS: Various patient and clinical factors are linked to the development and mortality of Fournier's gangrene compared to perineal cellulitis. Improved access to care and understanding of Fournier's gangrene can enhance patient outcomes.

Nasal natural killer/T-cell lymphoma mimicking orbital cellulitis: A diagnostic dilemma.

Nasal natural killer/T-cell lymphoma (NK/TCL) is a rare form of malignant non-Hodgkin lymphoma (NHL) with a far more rare involvement of orbit. The orbital involvement has a highly variable clinical presentation. Here, we report one such case of a 40-year-old male patient who presented with swelling in the right upper and lower eyelids with the diminution of vision for 12 days. He had a history of blocked nose for two months. Clinical examination and CT scan of the orbit and paranasal sinuses suggested a diagnosis of right orbital cellulitis with pansinusitis. A combination of intravenous antibiotics was started, and functional endoscopic sinus surgery was done. Histopathology was a suggestive of nasal NK/TCLl NHL. After proper staging, the patient was given chemotherapy and radiotherapy. There was a complete resolution of mass with no recurrence over a follow-up of 10 months.

Granulomatosis with Polyangiitis Discovered Because of Repeated Upper Eyelid Swelling.

Background and objectives: The initial symptom that triggers granulomatosis with polyangiitis (GPA) diagnosis is rarely ocular. We describe a case with a single ocular lesion identified as probable GPA due to proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA)-positivity according to the diagnostic criteria of the Ministry of Health in Japan; the lesion repeatedly worsened. Materials and methods: A 25-year-old female visited the Department of Ophthalmology, Asahi General Hospital, with upper eyelid swelling and conjunctival and episcleral hyperemia of the left eye. Both hordeolum and eyelid cellulitis were suspected, as the condition was resistant to treatment with antibiotic eye drops. Episcleritis was suspected due to localized hyperemia in the upper part of the eye. Upon treatment with antibacterial agents and steroid eye drops, the swelling and the hyperemia repeatedly worsened every week. Results: Blood samples were positive for PR3-ANCA, and GPA with an isolated ocular lesion was considered. After oral steroid treatment, the patient had no recurrence for 4 years. There was no systemic involvement in the upper respiratory tract, lungs, or kidneys. Conclusions: Diagnosing GPA with ocular symptoms as initial manifestations is challenging. GPA should be considered in treatment-resistant eyelid, orbital, and episcleral lesions, even at a young age.

Comprehensive Statistical Approach to Investigate the Risk Factors Affecting the Occurrences of Cellulitis Episodes among Patients with Lymphedema.

Background: Cellulitis is an infection of the skin and the tissues just under the skin. As any disease, cellulitis has various physiological and physical effects that deteriorate a patient's quality of life. Luckily, cellulitis can be treated when dealt with in a timely fashion. Nonetheless, some patients may experience more than one episode of cellulitis or a recurrence of cellulitis that was previously cured. In fact, the occurrences of cellulitis episodes are believed to follow a statistical distribution. The frequency distribution of cellulitis episodes is scrutinized herein. We aimed to investigate the risk factors that affect the number of cellulitis episodes and the pattern of association between cancer types and cellulitis episodes by using analytical and visual approaches.Methods: A statistical approach applying a two-part count regression model was used instead of the traditional one-part count model. Moreover, multiple correspondence analysis was used to support the finding of count regression models.Results: The results of analysis of the sample from the National Cheng Kung University hospital in Taiwan revealed the mean age of patients was 58.7 ± 14.31 years old. The two-part regression model is conceptually and numerically better than the one-part regression model when examining the risks factors that affect cellulitis episodes. Particularly, we found the significant factors based on the best model are cellulitis history ([Formula: see text]; P value < 0.001), clinical stage of cancer (3) ([Formula: see text]; P value < 0.001), no cancer ([Formula: see text]; P value < 0.05), cancer of female reproductive organs ([Formula: see text]; P value < 0.05), breast cancer ([Formula: see text]; P value < 0.05), and age ≥ 60 years ([Formula: see text]; P value < 0.05). Multiple correspondence analysis approach found cancer types (breast and female reproductive organ), age ≥ 60 years, and cellulitis history were more likely to link to excess zero cellulitis or one cellulitis episode.

Chronic Cellulitis in Elephantiasis: A Rare Debilitating Phenomenon.

Chronic edema, which has multiple etiologies, is predicted to be a significant underlying cause of lymphedema, potentially leading to serious complications. Elephantiasis, characterized by massive swelling of any body part, is a rare but debilitating condition often associated with lymphatic obstruction or anomalies in the lymphatic system. Lymphedema can predispose a patient to cellulitis, an infectious condition with multiple risk factors. This case study presents a 45-year-old male with a history of chronic lymphatic obstruction due to elephantiasis and recurrent cellulitis in his lower limb. Despite receiving multiple courses of antibiotics, the patient continued to experience multiple episodes of cellulitis, along with worsening lymphedema and functional impairment of the limb. The mainstay of treatment for this condition includes compression stockings and surgery, but addressing the root cause of the disease is crucial. Typically, a multidisciplinary approach is required, involving antibiotics, lymph drainage, and compression therapy. This case highlights the challenges faced in managing elephantiasis and its related complications and emphasizes the need for preventive strategies.

Emergency department referrals for CT imaging of extremity soft tissue infection: before and during the COVID-19 pandemic.

Objectives: To evaluate the incidence and spectrum of findings in patients referred for CT imaging of extremity soft tissue infection in the adult emergency department (ED) setting before and during the COVID-19 pandemic. Methods: Two hundred thirteen CT exams in the pre-COVID cohort (February 1, 2018-January 31, 2020) and 383 CT exams in the COVID cohort (February 1, 2020-January 31, 2022) were evaluated in this multicentre, retrospective study. Demographic information and clinical histories were collected, along with regional data on COVID-19 hospitalizations and deaths. Results: Comparable age and sex distribution was found in the pre-COVID (average age of 53.5 years; male: female ratio of 71:29) and COVID (average age of 54.6 years; male: female ratio of 69:31) cohorts. The frequency of reported clinical risk factors (diabetes mellitus, injected drug use, prior surgery, animal bite) was not significantly different between the two cohorts. Findings of simultaneous involvement of both superficial and deep soft tissue infection on CT imaging were significantly higher in the COVID cohort (53.4%) than in the pre-COVID cohort (33.7%). CT findings of phlegmon (49.1% vs 22.1%), ulcers (48.8% vs 30%), osteomyelitis (21.7% vs 13.1%), as well as localized (18.8% vs 11.7%) and extensive (3.7% vs 2.3%) soft tissue gas were significantly more common in the COVID cohort than in the pre-COVID cohort. Conclusions: During the COVID-19 pandemic, the number of ED CT exams for the evaluation of extremity soft tissue infection increased, with this imaging also showing more advanced disease. Pandemic-related modifications to human behaviour and re-distribution of healthcare resources may underlie these observed changes. Advances in knowledge: This multi-centre study shows an increase in extremity soft tissue infection presenting to the ED during the pandemic. This finding is important for future pandemic preparations, as it can aid in the decision-making process around resource allocation.

A vexing case of a 73-year-old man with fevers, orbital cellulitis, and asymptomatic interstitial lung disease.

VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is a rare and recently identified disease resulting from a somatic mutation in the X-linked UBA1 gene in cells of myeloid lineage. It can present in a myriad of ways with the potential to affect various organ systems, including the lungs. VEXAS is usually steroid responsive, but no strong data exists for the use of a steroid-sparing agent. There is limited emerging evidence for haematopoietic stem cell transplantation in a select number of cases. Regardless, prognosis for this condition is poor and a treatment algorithm remains a priority. Herein, we present a case of VEXAS that came to attention with discovery of a relatively asymptomatic interstitial lung disease and led to recurrent febrile episodes with evolving multi-organ involvement.

Gangrena de Fournier secundaria a cuerpo extraño: Reporte de caso / Fournier's gangrene secondary to a foreign body: Case report

Introducción. La gangrena de Fournier es un proceso infeccioso progresivo que compromete piel, tejido celular subcutáneo, grasa y fascia subyacente, con una incidencia de 1,6 pacientes por cada 100.000 personas/año. Se considera una urgencia quirúrgica, que requiere de manejo oportuno, ya que puede llegar a ser fatal, con una tasa de mortalidad del 20 al 35 %, que es más alta en hombres, en la tercera década de la vida y en pacientes inmunocomprometidos. Caso clínico. Se presenta el caso clínico de un paciente masculino de 44 años de edad, quien cursó con gangrena de Fournier secundaria a una espina de pescado de 5 cm de largo, incrustada en la unión anorrectal. Resultados. El paciente fue manejado por urología y cirugía general, requirió hospitalización en la Unidad de Cuidados Intensivos y curaciones por parte de terapia enterostomal, con resultados satisfactorios. Conclusiones. Sus posibles causas son múltiples y en ocasiones puede ser desencadenada por un factor externo, como un cuerpo extraño. Uno de los factores predisponentes es la obesidad. El diagnóstico oportuno y un tratamiento con intervención multidisciplinaria mejoran la sobrevida y la calidad de vida de los pacientes.

Introduction. Fournier's gangrene is a progressive infectious process that involves skin, subcutaneous tissue, fat and underlying fascia, with an incidence of 1.6 per 100,000 people/year. It is considered a surgical emergency, which requires timely management since it can be fatal, with a mortality rate of 20 to 35%, which is higher in men, in the third decade of life and in immunocompromised patients. Clinical case. Clinical case. A 44-year-old male patient is presented with Fournier's gangrene secondary to a 5 cm long fishbone embedded in the anorectal junction. Results. The patient was managed by urology and general surgery, requiring hospitalization in the ICU and treated by enterostomal therapy with satisfactory results. Conclusions. Its possible causes are multiple and sometimes it can be triggered by an external factor, such as a foreign body. One of the predisposing factors is obesity. Timely diagnosis and treatment with multidisciplinary intervention improve survival and quality of life of patients

Bisphosphonate-Induced Orbital Cellulitis in a Patient With Suspected Parathyroid Carcinoma: A Case Report.

Bisphosphonates are widely used for a number of metabolic bone conditions. Orbital inflammation is a very rare side effect of bisphosphonate therapy that can risk permanent visual loss. We describe the complex case and successful treatment of a 79-year-old man who developed orbital cellulitis following the use of intravenous pamidronate disodium for severe hypercalcaemia. The challenges regarding the diagnosis of parathyroid carcinoma are also discussed.

Subperiosteal abscess volume; an objective indication for surgical management in pediatrics.

PURPOSE: Subperiosteal abscess (SPA) can lead to devastating morbidity and mortality. Prompt management is important; however, the choice of management route is controversial. This study investigates factors associated with surgical management and defines a cut-off abscess volume prompting surgical intervention. METHODS: SPA cases presented to King Saud University Medical City (KSUMC) from 2014 to 2023 were reviewed. The surgical approach was studied in association with factors including age, gender, symptoms and signs, laboratory results, computed tomography (CT) characteristics, medications, and surgical approach. Multiple statistical tests were used for analysis, including student t-test, chi-square, multiple logistic regression analysis, and receiver operating characteristic (ROC) analysis. RESULTS: Patients were managed medically (n = 14, 45.16%) or surgically (n = 17, 54.84%). The average duration of antibiotics was 15 days. Superior SPA favors surgical management (OR = 6.722, CI [1.332-33.913], p = 0.029), along with the use of steroids (OR = 5.625, CI [0.915-34.572], p = 0.049), and abscess volume (OR = 10.003, CI [1.418-70.540], p < 0.001). However, the only factor attributing to a surgical decision on multivariate logistic regression analysis was abscess volume (OR = 5.126, CI [1.023-25.694], p = 0.047). SPA volume of ≥ 0.648 ml strongly prompts surgical management, with a sensitivity of 94.1% and a specificity of 71.4% (p = 0.000). CONCLUSION: SPA volume increases the likelihood of surgical intervention by five times, especially when abscess volume is ≥ 0.648 ml.

The Pulsing Paradox: Successful Steroid Therapy in Infection-Related Glomerulonephritis.

The patterns of infection-related glomerulonephritis (IRGN) are rapidly changing in terms of age at presentation and sources of infection. The existing literature on the use of steroids in IRGN is inconsistent. A diabetic male in his sixties presented with features of anasarca, bilateral flank pain, and acute pulmonary edema. He had a non-healing ulcer over his right leg, with pus culture showing growth of methicillin-resistant Staphylococcus aureus (MRSA). Computed tomography (CT) of the kidneys, ureter, and bladder (KUB) showed features of bilateral pyelonephritis. The patient went on to develop acute renal failure and eventually required hemodialysis. A renal biopsy was performed, and features of IRGN with crescents were noted. Considering the presence of crescents in renal biopsy, a trial of steroids was given under antibiotic cover, which resulted in a near-complete resolution of renal failure.

Orbital Complications After Cochlear Implant Surgery in a Patient With Silent Sinus Syndrome.

Cochlear implantation is an effective procedure for treating patients with severe to profound sensorineural hearing loss. Silent sinus syndrome (SSS) is an uncommon disease that affects the maxillary sinus. It is diagnosed clinically and confirmed radiologically. This study describes the case of a four-year-old child who presented with bilateral profound congenital hearing loss with a family history of congenital hearing loss. The patient had no significant complaints regarding the paranasal sinuses or orbits. Radiological evaluation, including temporal bone computed tomography (CT) and magnetic resonance imaging (MRI) of the ear and internal auditory meatus, showed normal anatomy of the inner ear and petrous bone bilaterally. However, findings of SSS were incidentally detected in the left maxillary sinus. The patient underwent bilateral simultaneous cochlear implantation. On the second postoperative day, he developed left-sided ophthalmoplegia, pain on eye movement, mild proptosis, and upper and lower eyelid swelling with erythema and tenderness. The patient improved rapidly following antibiotic treatment and was almost normal by the fifth postoperative day with no notable findings; hence, he was discharged. Surgeons should carefully evaluate preoperative radiological images of the paranasal sinuses for any malformation or pathology, so that appropriate medical or surgical treatment can be given.

Celulitis eosinofílica (síndrome de Wells) en una paciente en edad pediátrica / Eosinophilic cellulitis (Wells' syndrome) in a female pediatric patient

El síndrome de Wells o celulitis eosinofílica es una enfermedad inflamatoria de origen desconocido, de aparición infrecuente en la edad pediátrica. Suele manifestarse clínicamente como placas eritematoedematosas, nódulos, pápulas, ampollas, entre otros. Se presenta una paciente en edad pediátrica con nódulos subcutáneos asintomáticos generalizados asociados a eosinofilia grave. El estudio histopatológico de las lesiones fue compatible con celulitis de Wells. Se realizó una evaluación interdisciplinaria en busca de la causa y trastornos eosinofílicos asociados, sin resultados positivos. Se indicó tratamiento sistémico con corticoides y presentó buena respuesta, pero, ante la recidiva de las lesiones tras su suspensión, se indicó dapsona como tratamiento de segunda línea, con mejoría posterior de las lesiones y de la eosinofilia. El objetivo del reporte es presentar una paciente con una manifestación atípica de síndrome de Wells y su desafío terapéutico.

Wells' syndrome, or eosinophilic cellulitis, is an inflammatory disease of unknown origin, uncommon in the pediatric age. It usually appears clinically as erythematous and edematous plaques, nodules, papules, blisters, among other symptoms. Here we describe the case of a female pediatric patient with generalized, asymptomatic subcutaneous nodules associated with severe eosinophilia. The histopathological examination of the lesions was compatible with Wells' syndrome. An interdisciplinary evaluation was performed to establish the cause and look for associated eosinophilic disorders; the results were negative. Systemic corticosteroids were indicated and the patient had a good response; however, in view of the recurrence of the lesions after treatment discontinuation, dapsone was indicated as a second-line treatment, with subsequent improvement of the lesions and eosinophilia. The aim of this report was to describe the case of a female patient with an atypical manifestation of Wells' syndrome and the resulting therapeutic challenge.

Complicated Odontogenic Sinusitis: Extrasinus Infectious Spread.

Odontogenic sinusitis (ODS) is a common cause of orbital, intracranial, and osseous infectious extrasinus complications. Dental infections can spread to the orbital or intracranial spaces though the sinuses via thrombophlebitis or direct extension, or from the dentition or oral cavity via vascular channels in the maxillary alveolar bone. ODS typically presents with unilateral involvement both clinically and radiographically. Any suspicion for extrasinus spread based on history and physical examination should be followed by appropriate imaging, formal dental evaluation, and, when appropriate, ophthalmology and neurosurgery consultations. This multidisciplinary approach ensures appropriate management of both the acute orbital and intracranial complications.