Wegener's Granulomatosis Presenting as a Parapharyngeal Mass.

BACKGROUND: Wegener's Granulomatosis (WG) is classically characterized by the triad of sinonasal, pulmonary, and renal manifestations. However, a growing body of research has demonstrated that atypical head and neck pathologies including retropharyngeal and parapharyngeal lesions are often the presenting feature of patients found to have WG. CASE: This report describes the hospital course of a patient who presented with a parapharyngeal mass with secondary superior cervical chain compression and Lemierre's Syndrome. We discuss how a stepwise approach involving a multidisciplinary team led to the diagnosis of WG. CONCLUSIONS: To our knowledge, this report is the first description of a patient presenting with a parapharyngeal mass causing superior cervical chain compression with simultaneous Lemierre's Syndrome who was ultimately diagnosed with WG. We highlight how the early consideration of WG in patients with atypical head and neck lesions refractory to multiple treatment regimens can led to an expeditious diagnosis and the coordination of appropriate short-term and long-term care.

Facial swelling in a sickle cell patient.

Sickle cell disease (SCD) is characterized as a chronic hemolytic anemia with vaso-occlusive crises that result in multisystem organ damage. Bone marrow is one of the more common sites of these crises, presumably due to marrow hypercellularity that impairs blood flow- leading to regional hypoxia and subsequent infarction. Infarcts of facial bones are considered an uncommon complication of SCD. When infarcts occur in facial bones, the mandible and orbital bones are the most commonly affected. Overall, the clinical presentation of facial bone infarctions may mimic an infectious process, such as cellulitis, an abscess, or, more commonly, osteomyelitis. The purpose of this paper was to present the case of a patient with a confluence of symptoms in the face as a result of her sickle cell disease.