[Medical handicap and otorhinolaryngologic foreign bodies about 4 original cases]. / Handicap et Corps Etrangers ORL, a propos de quatre observations originales.

The multiple variant of aero-digestive foreign bodies' pathology determine many complex aspects with regard to their physiopathology, nature, and their location. The presence of a medical handicap or any particular condition could increase morbidity and expose to major risks. We are reporting here about 4 cases including an esophagus foreign body in a leprosies patient, an esophago-gastric case in a mental disorder patient, and two laryngeal-tracheal-bronchial cases during epileptic episodes. From the rarity of such accidents in an adult to their happening during a loss of consciousness or a delirious state, the clinical history is always missing. The symptoms are atypical and may misguide. The classical penetration syndrome cannot be reported. Only a clinical examination carefully conducted and completed with targeted para clinical examinations can help make early diagnosis. Endoscopy of the Esophagus on one hand, and endoscopy of the trachea and lungs on the other hand were used to extract these foreign bodies.

Lymphangioleiomyomatosis: a rare cause of breathlessness.

A 24-year-old female presented with complaints of cough with scanty expectoration, breathlessness on exertion and chest pain for the last three years. These symptoms had appeared during the 12th week of her third pregnancy. She was given anti-tuberculosis treatment at another hospital for nine months without any improvement in symptoms. Four years ago she had been diagnosed to have leprosy of borderline variety for which she had received treatment. On examination, she was tachypnoeic with a respiratory rate of 33 breaths per minute. She had clubbing and small, discrete and firm lymph nodes in the anterior cervical region. Chest examination revealed wheezing with bibasilar end-inspiratory crepitations.

Laryngeal sarcoidosis: treatment with the antileprosy drug clofazimine.

Sarcoidosis is a chronic systemic granulomatous disease that occasionally affects the larynx. When the larynx is affected, the symptoms are frequently mild, but severe airway obstruction can occur. Although systemic corticosteroids are helpful, patients may become refractory to further drug administration. The current methods of treatment are here summarized, and the patient literature is reviewed. We also report a case of a young patient suffering from laryngeal sarcoidosis successfully treated by the antileprosy agent clofazimine and propose it as an alternative treatment of laryngeal sarcoidosis in patients refractory to corticosteroids.

[Atypical presentations of leprosy: apropos of 2 cases]. / Tableaux atypiques de lèpre: a propose de 2 cas.

This report describes two atypical cases of leprosy. A 48 year old male patient presented laryngeal dyspnea with adhesions of the oropharynx of which the biopsies were inconclusive. The patient was cachectic with hyperesthesia of the extremities and two subcutaneous nodules. The biopsy of one nodule evoked thesaurismosis or dyslipoidosis while the bacilloscopy was positive in nasal smears. A 14 year old female patient suffered from bullae which appeared spontaneously on erythematous skin on the legs and upper arms. Upon examination those areas were found to be hypoaesthetic, as was a very large hamartoma on the left half of the body. A biopsy of healthy skin evoked the diagnosis of leprosy. The patient then developed BT leprosy and episodes of hysteria. The first observation led to several diagnoses: while laryngeal dyspnea is unusual in LL and while cutaneous histology of regressive LL contrasted with the abundance of the bacilloscopy. The diagnosis of the second case is that of indeterminate leprosy with premonitory neurological signs associated with pathomania and evolution to a multibacillary form.