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Tidsskrift For Den Norske Laegeforening... Mar 2023A young boy presented with acute ethmoiditis and recurrent periorbital swelling. The periorbital swelling was confirmed to be caused by a rare condition.
BACKGROUND
A young boy presented with acute ethmoiditis and recurrent periorbital swelling. The periorbital swelling was confirmed to be caused by a rare condition.
CASE PRESENTATION
Debut symptoms were acute rhinitis, unilateral periorbital swelling, fatigue, and swelling in the temple region, probably caused by an insect bite. Magnetic resonance imaging (MRI) of the sinuses showed bilateral ethmoiditis and unilateral periorbital cellulitis without subperiostal abscess formation, and antibiotics were prescribed. Because of recurrence of the periorbital swelling, an interdisciplinary team started an investigation for a differential diagnosis. The infestation of Hypoderma tarandi was confirmed by recent history of hiking in reindeer habitat, typical clinical presentation and detection of IgG hypodermin C antibodies.
INTERPRETATION
Human myiasis by Hypoderma tarandi is a rare condition in Norway. Typical clinical signs are unaffected general condition, migration of swelling in the forehead, recurrent unilateral periorbital swelling and normal CRP levels. Early-stage diagnosis and treatment will contribute to rapid symptom relief and prevent rare eye and intracranial complications. This case illustrates the importance of investigation for other conditions when the disease course is unexpected. The authors emphasise that knowledge about this disease is important in a variety of medical specialties.
Topics: Male; Animals; Humans; Child; Diptera; Myiasis; Eye Diseases; Edema; Acute Disease; Reindeer
PubMed: 36919299
DOI: 10.4045/tidsskr.22.0434 -
Turkish Neurosurgery 2020To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cranial intraosseous meningiomas (IOMs).
AIM
To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cranial intraosseous meningiomas (IOMs).
MATERIAL AND METHODS
This study included ten patients (six females and four males) with IOMs who underwent cranial CT and/ or MRI examinations during May 2009?June 2018. Lesions were classified based on the following locations: the sphenoid ridge, the calvarial convexity, other skull base bones, and the sphenoid ridge + calvarial extension. Bony extension, contour irregularity or radial bone spiculation, bony changes (hyperostotic, lytic, or mixed patterns), dural calcification, cerebral edema, and the presence of soft tissue were evaluated.
RESULTS
A total of eleven IOMs were identified in ten patients. The age of patients was 46?80 (mean: 55.30 ± 9.84) years. Five of the lesions were located in the sphenoid ridge + calvarium, three in the sphenoid ridge, two in the skull base, and one in the calvarial convexity. Seven lesions exhibited radial bone spiculation. Moreover, nine lesions exhibited hyperostotic CT pattern; while, two exhibited a mixed pattern. Three IOMs were accompanied with dural calcification, and peritumoral edema was observed in six IOMs.
CONCLUSION
IOMs are predominantly low-grade tumors, commonly located in the periorbital area and often accompanied by soft tissue components and dural infiltrations. They most commonly lead to radial bone spiculation and bone expansion. Patients primarily have single lesions but may occasionally have multiple ones.
Topics: Aged; Aged, 80 and over; Brain; Brain Edema; Calcinosis; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Sphenoid Bone; Tomography, X-Ray Computed
PubMed: 31608974
DOI: 10.5137/1019-5149.JTN.25694-18.4 -
Clinical Cancer Research : An Official... Sep 2021PD-1/PD-L1 inhibitors are approved for multiple tumor types. However, resistance poses substantial clinical challenges.
A Phase I Study of APX005M and Cabiralizumab with or without Nivolumab in Patients with Melanoma, Kidney Cancer, or Non-Small Cell Lung Cancer Resistant to Anti-PD-1/PD-L1.
PURPOSE
PD-1/PD-L1 inhibitors are approved for multiple tumor types. However, resistance poses substantial clinical challenges.
PATIENTS AND METHODS
We conducted a phase I trial of CD40 agonist APX005M (sotigalimab) and CSF1R inhibitor cabiralizumab with or without nivolumab using a 3+3 dose-escalation design (NCT03502330). Patients were enrolled from June 2018 to April 2019. Eligibility included patients with biopsy-proven advanced melanoma, non-small cell lung cancer (NSCLC), or renal cell carcinoma (RCC) who progressed on anti-PD-1/PD-L1. APX005M was dose escalated (0.03, 0.1, or 0.3 mg/kg i.v.) with a fixed dose of cabiralizumab with or without nivolumab every 2 weeks until disease progression or intolerable toxicity.
RESULTS
Twenty-six patients (12 melanoma, 1 NSCLC, and 13 RCC) were enrolled in six cohorts, 17 on nivolumab-containing regimens. Median duration of follow-up was 21.3 months. The most common treatment-related adverse events were asymptomatic elevations of lactate dehydrogenase ( = 26), creatine kinase ( = 25), aspartate aminotransferase ( = 25), and alanine aminotransferase ( = 19); periorbital edema ( = 17); and fatigue ( = 13). One dose-limiting toxicity (acute respiratory distress syndrome) occurred in cohort 2. The recommended phase 2 dose was APX005M 0.3 mg/kg, cabiralizumab 4 mg/kg, and nivolumab 240 mg every 2 weeks. Median days on treatment were 66 (range, 23-443). Median cycles were 4.5 (range, 2-21). One patient had unconfirmed partial response (4%), 8 stable disease (31%), 16 disease progression (62%), and 1 unevaluable (4%). Pro-inflammatory cytokines were upregulated 4 hours post-infusion. CD40 and MCSF increased after therapy.
CONCLUSIONS
This first in-human study of patients with anti-PD-1/PD-L1-resistant tumors treated with dual macrophage-polarizing therapy, with or without nivolumab demonstrated safety and pharmacodynamic activity. Optimization of the dosing frequency and sequence of this combination is warranted.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Antibodies, Monoclonal; Antineoplastic Agents, Immunological; Carcinoma, Non-Small-Cell Lung; Carcinoma, Renal Cell; Drug Combinations; Drug Resistance, Neoplasm; Immune Checkpoint Inhibitors; Kidney Neoplasms; Lung Neoplasms; Melanoma; Nivolumab
PubMed: 34140403
DOI: 10.1158/1078-0432.CCR-21-0903 -
Dermatologic Surgery : Official... May 2023Many modalities are used for periorbital rejuvenation, with a wide range of efficacy and safety. To achieve favorable outcomes with minimal downtime and adverse effects,...
BACKGROUND
Many modalities are used for periorbital rejuvenation, with a wide range of efficacy and safety. To achieve favorable outcomes with minimal downtime and adverse effects, professionals developed a hybrid laser, which allows simultaneous treatment with 2 wavelengths: fractional ablative and fractional nonablative lasers.
OBJECTIVE
To evaluate the safety and efficacy of a new hybrid laser for periorbital rejuvenation.
MATERIALS AND METHODS
This retrospective single-center study includes 24 patients who underwent a single-pass treatment with a CO 2 and 1570-nm hybrid laser for periorbital rejuvenation between 2020 and 2022. Patients' standardized clinical photographs before and after the treatment were assessed by 4 independent physicians for objective improvement. Treatment data, safety, and patients' satisfaction were also reviewed.
RESULTS
Statistically significant objective improvements were found in all investigated scales with an improvement of 1 to 2 points on each scale. Patients' satisfaction was 3.1/4. Average downtime was 5.9 ± 1.7 days. Most adverse effects were mild to moderate in severity (89.7%), including erythema, crusting, pruritis, edema, and hyperpigmentation.
CONCLUSION
After a single-pass treatment, the laser generates 26% to 50% improvement in the periorbital area, with a strong safety profile and a relatively simple recovery. Further research is needed to validate the efficacy of this technology compared with more aggressive modalities.
Topics: Humans; Rejuvenation; Retrospective Studies; Lasers, Solid-State; Skin Aging; Face; Patient Satisfaction; Treatment Outcome; Laser Therapy
PubMed: 36877122
DOI: 10.1097/DSS.0000000000003750 -
Indian Journal of Ophthalmology Jan 2023Orbital cellulitis is a serious condition with potentially severe complications. Treatment requires interdisciplinary care and early introduction of antimicrobial...
PURPOSE
Orbital cellulitis is a serious condition with potentially severe complications. Treatment requires interdisciplinary care and early introduction of antimicrobial therapy. In our tertiary center, a team of pediatricians, pediatric ophthalmologists, and otorhinolaryngologists successfully participated in the management of pediatric periorbital/orbital cellulitis. This study aimed to demonstrate our interdisciplinary approach and to investigate clinical profile and management of pediatric periorbital/orbital cellulitis.
METHODS
A retrospective chart review was performed of all pediatric patients hospitalized for periorbital and orbital cellulitis in a tertiary hospital center from September 15, 2016, to March 15, 2020.
RESULTS
A total of 26 children-median age 2.7 years (range 0.5-12)-were treated during the study period. Disease presentation was unilateral, mainly during winter (n = 12) and autumn (n = 12), without ophthalmoplegia/proptosis. Seven patients had orbital cellulitis (Chandler classification of ≥III) and were older (6.5 years, P = 0.011) with sinusitis (P < 0.001), required surgery (P = 0.004), underwent longer antimicrobial treatment (13 days, P < 0.001), and had a longer length of hospital stay (13.43 days, P = 0.001). Orbital cellulitis occurred in a median of three days (range 1-12) of acute rhinosinusitis. Radiological survey was performed in 11 patients, whereas six patients were treated surgically. All intraoperatively collected cultures (sinus swabs) were positive, whereas Streptococcus pyogenes and Peptostreptococcus were isolated in five cases. All patients fully recovered. No recurrence was documented.
CONCLUSION
Sinusitis is associated with severe orbital cellulitis and surgical management. Orbital cellulitis occurred early in the course of acute rhinosinusitis, as a distinctive presentation of rhinosinusitis. Interdisciplinary care and early management are crucial in treatment of pediatric periorbital/orbital cellulitis.
Topics: Child; Humans; Infant; Child, Preschool; Orbital Cellulitis; Retrospective Studies; Sinusitis; Acute Disease; Exophthalmos; Eye Diseases; Anti-Bacterial Agents; Orbital Diseases
PubMed: 36588244
DOI: 10.4103/ijo.IJO_798_22 -
Ocular Oncology and Pathology Dec 2020A masquerade syndrome is an atypical presentation of a neoplastic process that mimics an inflammatory condition. In this paper, we focus on orbital pseudocellulitis.
INTRODUCTION
A masquerade syndrome is an atypical presentation of a neoplastic process that mimics an inflammatory condition. In this paper, we focus on orbital pseudocellulitis.
CASE SERIES
Our case series includes 5 retinoblastoma patients with orbital pseudocellulitis at presentation. In 3 patients the disease was bilateral, in 1 trilateral, and in 1 unilateral. The eyes with pseudocellulitis were enucleated, while the fellow eyes were treated conservatively, when affected. Four patients responded well to the therapy and showed remission of the tumor. The patient with trilateral retinoblastoma did not respond to therapy and died of disease.
DISCUSSION
Differential diagnosis with infectious orbital cellulitis is extremely important. Patients with orbital cellulitis present with fever, sinusitis, leukocytosis, and raised inflammatory markers, while ophthalmoscopic examination is negative and imaging studies show sinus involvement. On the contrary, patients with retinoblastoma do not show systemic inflammation, while ophthalmoscopic examination reveals leukocoria, buphthalmos, and an intraocular tumor mass associated with retinal detachment. Magnetic resonance imaging shows intralesional calcifications and soft tissue edema without sinus involvement. Histology confirms the diagnosis.
CONCLUSIONS
Medical history, physical examination, and imaging studies are crucial in the diagnosis of retinoblastoma-associated orbital pseudocellulitis. Retinoblastoma should be excluded in all patients with signs of pre-septal orbital cellulitis through fundoscopy and/or imaging studies.
PubMed: 33447593
DOI: 10.1159/000509810 -
International Journal of Women's... Oct 2022
PubMed: 36249536
DOI: 10.1097/JW9.0000000000000051 -
Cureus May 2024Periorbital necrotizing fasciitis (NF) is a devastating bacterial infection associated with irreversible inflammatory destruction of soft tissues. Outcomes include...
Periorbital necrotizing fasciitis (NF) is a devastating bacterial infection associated with irreversible inflammatory destruction of soft tissues. Outcomes include disfigurement, vision loss, septic shock, and death within hours to days. We describe two cases of periorbital NF that presented to our unit within a three-month period. We aim to highlight the key clinical features of periorbital NF, demonstrate the rapid progression of the disease, and the need for prompt identification and decisive intervention. Both patients presented with fever and left-sided periorbital swelling and showed rapid progression of swelling and gangrenous changes to the periorbital skin with worsening proptosis. They were treated with broad-spectrum intravenous antibiotics and underwent emergency surgical debridement of necrotic tissue followed by reconstruction. We propose a formal protocol that we recommend to aid the diagnosis and management of periorbital NF in an acute setting.
PubMed: 38826916
DOI: 10.7759/cureus.59501 -
Case Reports in Ophthalmology 2022A 72-year-old male patient was referred to our outpatient clinic with a painful left eye protrusion accompanied by marked conjunctival chemosis and external...
A 72-year-old male patient was referred to our outpatient clinic with a painful left eye protrusion accompanied by marked conjunctival chemosis and external ophthalmoplegia being progressed despite topical and oral antibiotic therapy. He developed ocular symptoms 9 days after receiving his second SARS-CoV-2 vaccine (VeroCell). Of note, in previous history, 2 weeks after the first dose of the COVID-19 vaccine, he also developed a life-threatening laryngeal oedema treated at an emergency care unit. MRI of the orbit excluded pansinusitis as possible origin of the orbital cellulitis, and repeated COVID-19 antigen and antibody PCR tests were negative during his hospitalization. On the next day after his admittance, parenteral dexamethasone 250 mg/die treatment was commenced resulting in a quick and complete resolution of the symptoms. Due to the facts regarding this case, such as the temporal coincidence and the lack of respective comorbidity, there might be a causative relationship between the vaccination and the presented orbital cellulitis. To the best of our knowledge, this is the first report on orbital cellulitis as a possible ocular adverse event following COVID-19 vaccination.
PubMed: 35611007
DOI: 10.1159/000523803 -
Clinical Ophthalmology (Auckland, N.Z.) 2021COVID-19 infection is a respiratory disease but it can have ophthalmological manifestations as well. This study aimed to investigate the ophthalmological implications of...
BACKGROUND AND AIM
COVID-19 infection is a respiratory disease but it can have ophthalmological manifestations as well. This study aimed to investigate the ophthalmological implications of COVID-19 either during the course of the disease or after recovery.
METHODS
A retrospective study included the records of 425 COVID-19 patients, proved by positive PCR swabs. The records were collected from three isolation hospitals in Gharbeya Governorate, Egypt.
RESULTS
The mean age of the studied group was 41.73 ± 13.59, and 216 (50.8%) of them were males. One hundred and thirty one (30.8%) patients had ophthalmological manifestations. Among the entire patients, the most common ophthalmological presentation was conjunctivitis in 111 patients (26.1%), followed by neuro-retinal affection in 9 (2.1%), secondary fungal orbital cellulitis in 6 (1.4%), episcleritis in 3 (0.7%) and keratitis in 2 (0.5%) patients. All of the observed ophthalmological implications occurred either during the course of the disease (concurrent) or after recovery, except for the fungal orbital cellulitis which occurred only after recovery.
CONCLUSION
COVID-19 could cause different eye manifestations. Recovery from the main disease does not guarantee eye safety, especially in high-risk patients.
PubMed: 34819718
DOI: 10.2147/OPTH.S336600