-
Clinical Case Reports Jun 2024Immunosuppression from B-acute lymphoblastic leukemia (B-ALL) chemotherapy and a preceding COVID-19 infection may predispose patients to rare complications such as...
Co-occurrence of rhino-orbital mucormycosis and acute lymphoblastic leukemia post-COVID-19 infection in a young adolescent male: A case report from a low middle-income country.
KEY CLINICAL MESSAGE
Immunosuppression from B-acute lymphoblastic leukemia (B-ALL) chemotherapy and a preceding COVID-19 infection may predispose patients to rare complications such as rhino-orbital mucormycosis. Hence, a high index of suspicion should be maintained by physicians (and oncologists) if patients undergoing B-ALL treatment present with orofacial symptoms and ophthalmological manifestations such as peri-orbital swelling, ophthalmoplegia, and loss of vision, suggestive of infection.
ABSTRACT
Mucormycosis is a severe fungal infection that poses significant mortality and morbidity risks, particularly in immunocompromised individuals. We present a rare case of a 16-year-old patient with rhino-orbital mucormycosis following B-acute lymphoblastic leukemia (B-ALL) treatment and concurrent COVID-19 infection. We describe the clinical presentation, diagnosis, treatment, and outcome of this patient, and discuss the possible interactions and implications of these three conditions. A young 16-year-old male patient without significant clinical history was admitted with complaints of low-grade intermittent fever, fatigue, malaise, restlessness, and unexplained weight loss for the past 2 months. A bone marrow biopsy confirmed the diagnosis of B-ALL. Following the diagnosis of B-ALL, the patient underwent initiation of chemotherapy. Following the initial two cycles of chemotherapy, the patient experienced fever and cough and tested positive for COVID-19 infection. Nearly a week later, the patient presented to the chemotherapy emergency department with a clinical picture characterized by a fever up to 39°C associated with left facial swelling, severe headache, purulent rhinorrhea, and foreign body sensation in the ipsilateral nostril. The following day, erythema and left eyelid edema were observed, with ocular opening limitation. The diagnosis was confirmed based on the positive result of polymerase chain reaction for left-sided mucormycosis. Initial administration of liposomal and lipid amphotericin B at 1-1.5 mg/kg/d doses for 4-6 weeks was followed by surgical debridement of necrotic tissue on the left side of the face and nose. Subsequent ophthalmological examinations showed normal conditions of the left eye. The case underscores the importance of heightened clinical suspicion, early diagnosis through imaging and molecular techniques, aggressive multimodal therapy, and close interdisciplinary collaboration for improved outcomes in such rare and challenging clinical scenarios.
PubMed: 38799526
DOI: 10.1002/ccr3.8972 -
AACE Clinical Case Reports 2024Although common in adults, primary hyperparathyroidism (PHPT) is a rare condition in children with the most common etiology being solitary parathyroid adenoma (PTA). The...
BACKGROUND/OBJECTIVE
Although common in adults, primary hyperparathyroidism (PHPT) is a rare condition in children with the most common etiology being solitary parathyroid adenoma (PTA). The typical presentation is symptomatic hypercalcemia. Management of PHTP secondary to PTA requires excision of the adenoma.
CASE REPORT
A 13-year-old adolescent boy presented because of orbital cellulitis and was noted to have hypercalcemia. Despite this, the patient was curiously asymptomatic. Further investigations yielded an elevated parathyroid hormone (PTH) level and a normal urine calcium-to-creatinine ratio making the most likely cause of hypercalcemia PHTP secondary to PTA. Imaging demonstrated PTA. The patient underwent parathyroidectomy with the pathology demonstrating PTA. Postoperatively, the PTH levels were undetectable; hence, the patient was treated with calcitriol and calcium supplementation for 1 month and 4 months, respectively. Genetic work-up for multiple endocrine neoplasia 1 and rearranged during transfection mutations was negative.
DISCUSSION
Solitary PTA is the most common cause of PHPT. Adenomas are mostly sporadic or may be a manifestation of an inheritable syndrome, such as multiple endocrine neoplasia. Although symptomatic disease is more common in children, our patient denied any hypercalcemia symptoms. The distinguishing biochemical feature of PHPT because of PTA is high or inappropriately normal PTH level in the context of high-normal or elevated serum calcium levels. Urinary calcium excretion is usually normal or high. PTAs are localized by ultrasound and Tc-99m-Sestamibi scintigraphy. Management includes parathyroidectomy and monitoring for postoperative hypocalcemia.
CONCLUSION
In a child or adolescent presenting with hypercalcemia and elevated PTH levels, it is important to consider PHPT secondary to PTA, because an early diagnosis will aid in preventing complications from hypercalcemia.
PubMed: 38799050
DOI: 10.1016/j.aace.2024.02.008 -
Cureus Apr 2024Pott's puffy tumor (PPT) is a rare but life-threatening complication of chronic sinusitis, although it can be secondary to other entities such as trauma or insect...
Pott's puffy tumor (PPT) is a rare but life-threatening complication of chronic sinusitis, although it can be secondary to other entities such as trauma or insect bites. It is characterized by circumscribed frontal swelling associated with a subperiosteal abscess. Imaging plays a crucial role in diagnosis and early identification of complications, some of which can be life-threatening, including intracerebral and intra-orbital complications. We present a case of a 14-year-old male with non-specific frontal pain and swelling, where the diagnosis of PTT was confirmed through imaging studies. Upon admission, the patient exhibited orbital and intracerebral complications, as shown in MRI and CT scans. Treatment involved a combination of antibiotics and sinus surgery, with close monitoring for orbital and intracranial complications.
PubMed: 38770497
DOI: 10.7759/cureus.58640 -
The Journal of International Medical... May 2024Fungal orbital cellulitis is usually seen in immunocompromised individuals, and opportunistic pathogens are the main etiology. We herein report a case of fungal orbital...
Fungal orbital cellulitis is usually seen in immunocompromised individuals, and opportunistic pathogens are the main etiology. We herein report a case of fungal orbital cellulitis due to in a patient with no history of trauma. A 48-year-old man presented to the emergency room of our hospital with a 2-week history of periorbital swelling, conjunctival hyperemia, and chemosis of his right eye. The visual acuity of his right eye was 6/20, and the intraocular pressure was 44 mmHg. The main clinical findings were proptosis of the right ocular globe with conjunctival hyperemia and a palpable infratemporal orbital mass. Laboratory testing failed to detect the presence of a pathogenic infection, and the lesions on computed tomography images resembled those of a malignant tumor of the orbit. The diagnosis was finally confirmed by postoperative pathological examination, and the patient responded favorably to debridement combined with antifungal therapy. Histopathological examination may help to reveal the nature of this disease. Surgical removal of inflammatory lesions can serve as an important diagnostic and treatment method for fungal orbital cellulitis.
Topics: Humans; Male; Middle Aged; Aspergillosis; Immunocompromised Host; Tomography, X-Ray Computed; Antifungal Agents; Orbital Cellulitis; Debridement; Eye Infections, Fungal
PubMed: 38757522
DOI: 10.1177/03000605241239857 -
Cureus Apr 2024Nephrotic syndrome (NS) is known to be a prevalent chronic illness in young patients. Periorbital swelling in children with this condition is a recurring symptom, either... (Review)
Review
Nephrotic syndrome (NS) is known to be a prevalent chronic illness in young patients. Periorbital swelling in children with this condition is a recurring symptom, either with or without generalized edema. The current study aimed to examine the incidence and pattern of nephrotic syndrome in infants and children by thoroughly examining the recently available literature. A thorough search of PubMed, SCOPUS, Web of Science, Science Direct, and Google Scholar was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, to find pertinent material. The Rayyan software (Qatar Computing Research Institute, Ar-Rayyan, Qatar) was utilized during the whole process. Data from a total of 1418 patients from nine trials were considered in this study. Numerous factors influenced the incidence, mean age, sex dominance, and histological patterns in various sample groups. The current findings conclude that variations in socioeconomic, regional, and genetic factors influence the development and pattern of these diseases. The prevalence of pediatric renal disorders differs throughout countries. Season of occurrence, response to corticosteroid treatment, and histopathologic findings appear to differ amongst the diagnosed cases.
PubMed: 38752042
DOI: 10.7759/cureus.58331 -
Indian Journal of Dental Research :... Oct 2023Pituitary microadenomas are said to be common, with an incidence of 27%. Hypothyroidism causing periorbital oedema (PO) remains rare in the literature, but it is still...
INTRODUCTION
Pituitary microadenomas are said to be common, with an incidence of 27%. Hypothyroidism causing periorbital oedema (PO) remains rare in the literature, but it is still within the etiological factors.
PATIENT CONCERNS
This study presents a 53-year-old patient who presented with PO and visited the dental clinic to exclude dental infection.
DIAGNOSIS
Based on the evaluation of proper haematological and radiological investigations, pituitary microadenoma was identified with an abrupt increase in the thyroid stimulating hormone (TSH) level.
FOLLOWUP
The patient was followed with further studies to identify the primary cause of PO. It was concluded that the disruption in the drug regimen caused an increase in the TSH and led to PO rather than microadenoma.
Topics: Humans; Middle Aged; Hypothyroidism; Edema; Male; Pituitary Neoplasms; Adenoma; Orbital Diseases; Thyrotropin
PubMed: 38739832
DOI: 10.4103/ijdr.ijdr_9_22 -
Cureus Apr 2024B-cell lymphoblastic lymphoma (B-LBL) is an abnormal proliferation of lymphocyte precursor cells located primarily outside of the bone marrow and peripheral blood,...
B-cell lymphoblastic lymphoma (B-LBL) is an abnormal proliferation of lymphocyte precursor cells located primarily outside of the bone marrow and peripheral blood, typically in the mediastinum or other lymph nodes. It is often a disease of childhood that presents with lymphadenopathy, fatigue, pallor, bone pain, and weight loss with laboratory findings of anemia and thrombocytopenia. Initial presentations prompted by head and neck manifestations are exceedingly rare. A five-year-old girl with no significant past medical history presented with right facial swelling and mild proptosis on ophthalmologic evaluation. She was referred to a tertiary care facility by her local otolaryngologist for further management after computed tomographic imaging revealed right maxillary sinus opacification and erosion of the anterior maxillary bone. Her symptoms were initially responsive to prednisone and amoxicillin-clavulanate, and only right unilateral nasal discharge persisted with a near-complete resolution of other sinonasal symptoms. Notably, laboratory values, including complete blood count, were within normal limits. Given concern for the etiology of the bony erosion, the patient presented for a second opinion, where imaging and biopsy resulted in flow cytometry findings consistent with B-ALL/LBL. After a bone marrow biopsy, the ultimate diagnosis was Murphy's stage III B-cell lymphoblastic lymphoma. Malignant neoplasms of the sinonasal region are rare in children, where primary sinonasal B-LBL is a unique occurrence. Clinical features of sinonasal B-LBL in the paranasal sinuses may masquerade as pathologies such as acute sinusitis, orbital cellulitis, and benign tumors or polyps that can lead to a confounding diagnosis. In this case presentation, an initial response to steroids and antibiotics should not provide false reassurance when other features and signs, such as maxillary bone erosion, may suggest the presence of malignancy.
PubMed: 38738089
DOI: 10.7759/cureus.58132 -
Cureus May 2024Hypothyroidism commonly presents with dermatological and hair-related symptoms, although the loss of eyelashes and eyebrows is considered uncommon in clinical practice....
Hypothyroidism commonly presents with dermatological and hair-related symptoms, although the loss of eyelashes and eyebrows is considered uncommon in clinical practice. Here, we present a case of milphosis secondary to uncontrolled hypothyroidism. A 24-year-old female with a history of hypothyroidism following total thyroidectomy and poor medication adherence presented with significant eyelash loss, accompanied by symptoms of dysphonia, bradyphrenia, bradylalia, constipation, pronounced fatigue, and drowsiness. Physical examination revealed periorbital edema and extensive eyelash loss affecting the upper eyelids. Laboratory analysis demonstrated a markedly elevated thyroid-stimulating hormone (TSH) level of 240.8 µIU/mL (normal range 0.38 to 5.33 µIU/L), confirming severe uncontrolled hypothyroidism. Levothyroxine treatment was reintroduced, leading to complete resolution of periorbital edema and regrowth of eyelashes after 12 weeks, coinciding with improvement in TSH levels. This clinical case adds to the limited literature on madarosis and milphosis as manifestations of hypothyroidism, emphasizing the importance of clinician awareness regarding their potential presentation in the context of the disease. Understanding these manifestations and their differential diagnoses is crucial for ensuring prompt and accurate diagnosis and treatment.
PubMed: 38707755
DOI: 10.7759/cureus.59551 -
JAAD Case Reports May 2024
PubMed: 38689864
DOI: 10.1016/j.jdcr.2024.02.016