Case Report: Successful Treatment with Miltefosine of Severe New World Mucosal Leishmaniasis Caused by Leishmania guyanensis.

An 88-year-old man with mutilating mucosal leishmaniasis (ML) involving septal perforation, with granulomas in the pharynx and larynx, was treated with oral miltefosine, 50 mg three times/day for 28 days. Miltefosine, an antineoplastic agent, is considered an alternative option for the treatment of ML, showing efficacies of 75-92% in Bolivia, Brazil, and Argentina. The patient denied having previous cutaneous (CL) leishmaniasis, and no CL lesions were recognized by physical examination. Parasites obtained from mucosal lesions were identified by cytochrome b gene sequencing as Leishmania guyanensis. Clinical cure was observed 2 months posttreatment, and no evidence of reactivation was observed in the 3-year follow-up. Adverse effects such as nausea, loss of appetite, and epigastric pain were experienced during treatment with miltefosine. There is a need for improved access to miltefosine in leishmaniasis-endemic areas of Latin America and a greater awareness of ML and its treatment among physicians working in endemic countries.

Rinomodelação ou rinoplastia não-cirúrgica: uma abordagem segura e reprodutível / Rhinomodelation or non-surgical rhinoplasty: a safe and reproducible approach

Introdução: A rinoplastia é uma cirurgia que muitas vezes apresenta resultados imprevisíveis, mesmo em mãos de cirurgiões experientes. Neste sentido, a rinomodelação com preenchedores é um procedimento não-cirúrgico para corrigir pequenas alterações externas nasais em casos específicos. Métodos: Os autores descrevem a técnica de aplicação de preenchedores (ácido hialurônico ou hidroxiapatita de cálcio) para modelação nasal. Foram incluídos todos os pacientes submetidos ao preenchimento nasal, entre 2009 e 2012. Foi avaliado o edema da ponta nasal, a dor e o grau de satisfação dos pacientes com o resultado. Resultados: Foram incluídos 39 pacientes no estudo. Com relação aos desfechos analisados com ácido hialurônico: 52% apresentaram edema leve; 74% tiveram dor leve; 15% se mostraram muito satisfeitos e 74% satisfeitos com o resultado. Com relação aos pacientes submetidos à rinomodelação com hidroxiapatita de cálcio: 67% apresentaram edema moderado; 50% dor moderada; 17% dor intensa e 84% se mostraram satisfeitos com o resultado. Conclusão: A rinomodelação com preenchedores reabsorvíveis é um procedimento simples, com resultados estéticos aceitáveis, sendo necessário um profundo conhecimento anatômico para diminuir o risco de complicações.

Introduction: Rhinoplasty often leads to unpredictable results, even in the hands of experienced surgeons. However, in specific cases, rhinomodelation with fillers, a non-surgical procedure to correct minor nasal external changes, can be used. Methods: This study describes the application technique of fillers (hyaluronic acid or calcium hydroxyapatite) for nasal modeling. Patients undergoing nasal filling between 2009 and 2012 were included. Edema of the nasal tip, pain, and the degree of patient satisfaction with the outcome were assessed. Results: Thirty-nine patients were included in the study. Regarding the outcomes of rhinomodelation with hyaluronic acid, 52% patients presented with mild edema, 74% had mild pain, 15% were very satisfied, and 74% were satisfied with the result. For the outcomes of rhinomodelation with calcium hydroxyapatite, 67% patients presented with moderate edema, 50% had moderate pain; 17% had severe pain, and 84% were satisfied with the result. Conclusion: Rhinomodelation with resorbable fillers is a simple procedure with acceptable esthetic results. However, a deep anatomical knowledge is necessary to decrease the risk of complications.

[Nasal phaeohyphomycosis by Curvularia spicifera in pediatric patient with neutropenia and acute myeloid leukemia]. / Feohifomicosis nasal por Curvularia spicifera en un paciente pediátrico con neutropenia y leucemia mieloide aguda.

There are very few reports of pediatric patients with infections by dematiaceous filamentous fungi. In this publication we report a case of invasive fungal infection of the nasal septum by Curvularia spicifera in a pediatric patient with acute myeloid leukemia. The patient presented with a painful scabby wound in the nasal vestibule. Culture and universal PCR were consistent with Curvularia spicifera. Early management with surgical debridement and bi-associated antifungal therapy achieved complete resolution of the lesions, with no evidence of dissemination and relapses. Clinical management of these fungal infections represents a challenge as the antifungal selection and duration of therapy is not yet well stablished.

Feohifomicosis nasal por Curvularia spicifera en un paciente pediátrico con neutropenia y leucemia mieloide aguda / Nasal phaeohyphomycosis by Curvularia spicifera in pediatric patient with neutropenia and acute myeloid leukemia

There are very few reports of pediatric patients with infections by dematiaceous filamentous fungi. In this publication we report a case of invasive fungal infection of the nasal septum by Curvularia spicifera in a pediatric patient with acute myeloid leukemia. The patient presented with a painful scabby wound in the nasal vestibule. Culture and universal PCR were consistent with Curvularia spicifera. Early management with surgical debridement and bi-associated antifungal therapy achieved complete resolution of the lesions, with no evidence of dissemination and relapses. Clinical management of these fungal infections represents a challenge as the antifungal selection and duration of therapy is not yet well stablished.

Existen pocos reportes de infecciones por hongos dematiáceos en pediatría. Comunicamos el caso de una infección fúngica invasora del tabique nasal en un niño con una leucemia mieloide aguda, que se presentó como una lesión costrosa dolorosa en el vestíbulo nasal. Se realizó desbridamiento quirúrgico precoz y recibió tratamiento antifúngico biasociado, lográndose resolución completa de las lesiones, sin diseminación ni recaídas. El cultivo y la RPC universal fueron compatibles con Curvularia spicifera. El manejo de estas infecciones fúngicas representa un desafío, considerando que la elección del agente antifúngico y la duración de la terapia no están completamente establecidas.

Pedicle Tongue Flap for Palatal Fistula Closure.

BACKGROUND: Palatal fistulae are common sequels that appear in patients after surgical procedures in the palate. Considering the difficulty to achieve an effective treatment, there are many techniques to surgically manage fistulae, that is, the pedicle tongue flap. OBJECTIVE: Being so, the main goal of this paper is to report cases of patients with palatal fistulae, from different etiologies, treated with anterior pedicle tongue flap. PATIENTS: Eleven patients, 8 male and 3 female, mean age of 32 years old with palatal fistulae surgically treated with anterior dorsal tongue flaps. No flap was completely lost. There was 1 partial loss and 1 residual buconasal communication. The most common complaints of the patients were difficulty to perform oral hygiene and mild pain. CONCLUSION: The use of anterior pedicle tongue flap for closing palatal fistulae demonstrates to be a safe procedure with high success rates (81% in this paper) when correctly indicated.

Leishmaniasis mucosa nasolaringotraqueal en un adolescente / Nasolaryngotracheal mucosal leishmaniasis in an adolescent

La leishmaniasis es un problema creciente de salud pública, que produce un gran impacto social. La leishmaniasis laríngea y sin puerta de entrada evidente es rara, en especial en pacientes inmunocompetentes. Describimos un caso de leishmaniasis laríngea con extensión traqueal y estenosis secundaria en un adolescente previamente sano y sin factores de riesgo ambiental o personal.

Leishmaniasis is a growing public health problem and it produces a great social impact. Laryngeal leishmaniasis without obvious gateway is rare; especially in immunocompetent patients. We report a case of laryngeal leishmaniasis with tracheal involvement and stenosis on a previously healthy teenager without environmental or personal risk factors.

[Nasolaryngotracheal mucosal leishmaniasis in an adolescent]. / Leishmaniasis mucosa nasolaringotraqueal en un adolescente.

Leishmaniasis is a growing public health problem and it produces a great social impact. Laryngeal leishmaniasis without obvious gateway is rare; especially in immunocompetent patients. We report a case of laryngeal leishmaniasis with tracheal involvement and stenosis on a previously healthy teenager without environmental or personal risk factors.

Intranasal tooth and associated rhinolith in a patient with cleft lip and palate.

We report the case of a 9-year-old girl who presented with a complaint of a malodorous bloody discharge from the left naris. The patient had previously undergone a complete repair of left-sided cleft lip and palate. Clinical examination revealed hyperplasia of the nasal mucosa on the left side. X-ray examination of the nasal cavity demonstrated a radiopaque structure that resembled a tooth and a radiopaque mass similar to an odontoma that was adherent to the root of the suspected tooth. With the patient under general anesthesia, the structure was removed. On gross inspection, the structure was identified as a tooth with a rhinolith attached to the surface of its root. Microscopic examination revealed normal dentin and pulp tissue. A nonspecific inflammatory infiltrate was observed around the rhinolith, and areas of regular and irregular mineralization were seen. Some mineralized areas exhibited melanin-like brownish pigmentation. Areas of mucus with deposits of mineral salts were also observed. Rare cases of an intranasal tooth associated with a rhinolith have been described in the literature. We believe that this case represents only the second published report of an intranasal tooth associated with a rhinolith in a patient with cleft lip and palate.

Rhinoliths causing palatal perforation: case report and literature review.

Rhinoliths are calcified masses formed within the nasal cavity because of the solidification of mucus, debris, or foreign objects by gradual accretion of mineral salts. They are mostly asymptomatic and incidentally diagnosed, although some patients may complain of nasal discharge and obstruction. Ulceration of the nasal mucosa, facial swelling, and bone destruction are less frequently observed but bring about difficulties for differential diagnoses with several pathologic entities. This article presents a case of a 54-year-old woman with a rhinolith causing palatal perforation, focusing on the diagnostic process and histopathologic characteristics.

Nasal histoplasmosis in the acquired immunodeficiency syndrome.

Disseminated histoplasmosis is a disease with a high case-fatality rate, especially in patients with the acquired immunodeficiency syndrome (AIDS). The disease can occur in various sites, such as the lungs, eyes, oral cavity, larynx, nervous system, gastrointestinal tract and, more rarely, the nasal sinus region. It is a cosmopolitan mycosis with a high prevalence in Brazil. Nasal manifestation of the disease is rare, with only three cases reported in the literature, but it is part of the differential diagnosis for other granulomatous diseases, such as Wegener's granulomatosis, tegumentary leishmaniasis and nasal lymphoma. The authors of this study present a literature review and report a case of nasal histoplasmosis in a patient with AIDS. No record of such an aggressive presentation has been reported previously in the literature.

Disquinesia ciliar primaria: su presentación en Otorrinolaringología: Experiencia con 14 pacientes / Primary ciliar dyskinesia: its presentation in otolaringology: experience with 14 patients

La disquinesia ciliar primaria (DCP) es una enfermedad subdiagnosticada que suele tener manifestaciones importantes en Otorrinolaringología. Se analizan 14 pacientes en quienes el diagnóstico de DCP se basó en la persistencia de infecciones crónicas, ya sea a nivel nasosinusal u ótico. Las patologías más frecuentemente involucradas fueron la rinosinusitis crónica y la otitis media con efusión. El diagnóstico se hizo con microscopía electrónica de transmisión de mucosa bronquial. La alteración ciliar encontrada más reiteradamente fue la ausencia del brazo interno de dineína. En 6 pacientes se debió realizar cirugía endoscópica funcional de cavidades perinasales debido a una rinosinusitis crónica y, en 8, se debió colocar tubos de ventilación, por la otitis media con efusión persistente.

Naso-orbicular tissue necrosis by Streptococcus parasanguis in a patient with Fanconi anemia: clinical and laboratory aspects.

Fanconi anemia (FA) is a rare autosomal recessive disorder, characterized by pancytopenia and progressive hypoplasia of the bone marrow. A 23-year-old woman with FA showed severe pancytopenia and developed an abscess on the infraorbicular region on the right side of the face that progressed to phlegmon and caused tissue necrosis of the nostrils, nasal septum, nasal fossa, and posterior orbital region. Laboratory examination showed Streptococcus parasanguis as the etiologic agent of the phlegmon. Supportive treatment was recommended due to donor incompatibility for bone marrow transplant. The intraoral examination showed spontaneous gingival bleeding, edema of the interdental papillae, hematomas on the superior and inferior lips, bacterial and fungal infections, and adequate oral hygiene. The patient was treated with the administration of an antibiotic (imipenem), an antifungal (amphotericin B), and mouth washing with antiseptic solutions. Periodontal prophylaxis and orientation to and control of oral hygiene and diet were also used during the remission period. For functional and esthetic rehabilitation of the alar regions and nasal dorsum, an acrylic resin nasal prosthesis was made, supported by a spectacle frame.

Trombose séptica de seios cavernosos, transverso e sigmóide e de veia jugular, associada à meningite, secundária a furúnculo nasal: relato de caso / Septic thrombosis of cavernous, transverse, sigmoid sinuses and jugular vein, associated with meningitis, secondary to nasal furuncle: case report

Os autores descrevem um caso de furúnculo nasal que evoluiu com trombose séptica de seio cavernoso, bilateral e assimétrica, e de seios transverso e sigmóide e de veia jugular interna a esquerda, associada à meningite bacteriana, em um paciente previamente hígido. Apesar da trombose séptica extensa de seios venosos, o paciente apresentou boa evoluçäo, após tratamento clínico agressivo com antibióticos, corticosteróides e anticoagulantes. Porém, manteve como seqüela: paresia de VI nervo à esquerda e lesäo parcial de nervo óptico homolateral.

Mucormicose rinocerebral: relato de um caso / Rhinocerebral mucormycosis: report of case

Mucormicose é uma infecçäo fúngica com alta mortalidade, existindo sob as formas: craniofacial, pulmonar, cutânea, gastrointestinal e disseminada; ocorrendo em pacientes debilitados, devido a patologias crônicas. Relatamos aqui um caso de mucormicose renicerebral em paciente diabético, tratado com cirurgia e medicamento (U)

Diagnóstico de 2 casos de mucormicosis rino-facio-cerebral en pacientes diabeticos / Diagnosis two cases de rhino-facio-cerebral mucomycosis in diabetic patients

Se presentan dos casos de mucormicosis rino-facio-cerebral de evolución lenta, en pacientes diabéticos. El diagnóstico se realizó por el hallazgo del hongo en el exámen histopatológico y exámenes microcópicos de los materiales drenados de los senos maxilares, que mostraron hifas no septadas y abundantes. En ninguno de los casos se pudo recuperar el agente etiológico por cultivo, debido a la labilidad de los mucorales y por la presencia de un material necrótico de fácil contaminación microbiana

Diagnóstico de 2 casos de mucormicosis rino-facio-cerebral en pacientes diabeticos / Diagnosis two cases de rhino-facio-cerebral mucomycosis in diabetic patients

Se presentan dos casos de mucormicosis rino-facio-cerebral de evolución lenta, en pacientes diabéticos. El diagnóstico se realizó por el hallazgo del hongo en el exámen histopatológico y exámenes microcópicos de los materiales drenados de los senos maxilares, que mostraron hifas no septadas y abundantes. En ninguno de los casos se pudo recuperar el agente etiológico por cultivo, debido a la labilidad de los mucorales y por la presencia de un material necrótico de fácil contaminación microbiana

[A case of entomophthoromycosis caused by Conidiobolus coronatus]. / Un caso de entomophthoromicosis por Conidiobolus coronatus.

The authors report a case of entomophthoromicosis caused by Conidiobolus coronatus, a saprophytic fungus that belongs to the class Zygomycetes (Phycomycetes in the past). Our patient was from a rural area. The paranasal sinuses had been drained surgically and a polyp was removed from his nasal cavity. He had a deformity in the face and nasal obstruction. His general condition and immunological status were normal except for epistaxis since childhood. The diagnosis was made clinically by the appearance of the lesion and confirmed by the mycological and histopathological findings. The therapeutic response was slow but with total resolution of the lesion.