Cases reported "Lymphadenitis"

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11/36. Atypical mycobacterial tuberculosis--a diagnostic and therapeutic dilemma? case reports and review of the literature.

    In immunocompetent preschool children cervical lymphadenitis is a common clinical presentation of atypical mycobacteria. Its rapid diagnosis and treatment is still a challenge, because accurate diagnostic procedures for atypical mycobacteria are still not yet available in routine practice. Two children suffered from craniojugular (16 months old girl) and infraauricular (2.5 years old boy) located neck masses which showed resistance to the medical treatment. In the first case an abscess splitting took place initially, followed by an anti-tubercular drug treatment and necessary surgical reintervention. In the second case surgical removal of all involved lymph nodes, infiltrated surrounding soft tissue and involved skin areas were followed by medical treatment. In both cases presumed infection with mycobacterium tuberculosis was not confirmed, but atypical mycobacteria could be isolated both. In the first case atypical mycobacterium could be specified as mycobacterium avium complex and in the second case as mycobacterium malmoense. Both bacilli showed sensitivity towards medical treatment with clarithromycin, whereby in one case only the surgical reintervention led to a complete removal of clinical symptomatic. In cases of presumed tuberculous neck lymph node infections differential diagnosis of an atypical mycobacterial lymphadenitis should always be supposed, because medical and surgical treatment differ fundamentally.
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12/36. Management of isolated extrapulmonary tuberculosis in a pregnant patient.

    The worldwide incidence of tuberculosis is increasing, largely as a consequence of both the increasing prevalence of human immunodeficiency virus and the emergence of drug-resistant strains. The pulmonary system is typically the primary site of involvement by this infectious disease; however, extrapulmonary disease does occasionally occur. Although uncommon, neck involvement can occur. The usual presentation is bilateral adenopathy from pulmonary dissemination. Tuberculous cervical adenitis in the absence of pulmonary findings is rare. A concurrent diagnosis of pregnancy complicates the treatment of the infected patient. We present a case of isolated, unilateral tuberculous cervical adenitis in a pregnant patient and discuss the multidisciplinary approach necessary for the appropriate management of this unique situation.
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13/36. Atypical mycobacterial cervical lymphadenitis with extensive local spread: a surgical disease.

    Atypical (nontuberculous) mycobacterium is an uncommon cause of cervical lymphadenitis in immunocompetent children. Rarely, this disease progresses to locoregional destruction of the deep structures of the neck including salivary glands. Recent reports suggest medical monotherapy as an effective treatment of this disease. We report three cases of children who experienced progression to locoregional disease while on appropriate antibiotics. We suggest that the patient population to benefit from medical monotherapy has yet to be adequately defined. In our experience, surgical therapy is the only effective treatment for locoregional disease.
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14/36. Recognition of retropharyngeal abscess in children.

    retropharyngeal abscess is a rare deep-neck infection that usually affects young children. Swelling in the neck can lead to sudden and fatal airway obstruction. Enlargement of lymph nodes located between the posterior pharyngeal wall and the prevertebral fascia occurs secondary to infection of the nasopharynx, paranasal sinuses or middle ear. Penetrating trauma or foreign-body penetration may also lead to abscess formation. Common symptoms include fever, swollen neck, difficult swallowing, muffled voice and hyperextension of the head and neck. Lateral neck radiographs confirm the diagnosis. Early surgical treatment prevents serious complications, such as mediastinal spread, aspiration of pus, airway obstruction or erosion into a major vessel.
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15/36. Six cases of suppurative lymphadenitis caused by burkholderia pseudomallei infection.

    melioidosis, an infection caused by burkholderia pseudomallei, is endemic in Southeast asia and northern australia. It can have various presentations, ranging from acute septicaemia to chronic localized infection. Uncomplicated, localized infection usually involves skin or subcutaneous tissues. Suppurative lymphadenitis caused by melioidosis has been rarely encountered by clinicians practicing in endemic areas. We encountered six cases of suppurative lymphadenitis caused by burkholderia pseudomallei in adults who were admitted to hospital in singapore from 1997 to 2000. The most striking difference between these patients and cases reported previously was the pattern of the lymph node involvement. In the majority of previously described patients the infected lymph nodes were in the head and neck region. By contrast, four patients in our study presented with unilateral, inguinal lymphadenitis. Another two patients presented with mediastinal lymphadenitis and prolonged fever. All patients had prompt and sustained response to therapy. melioidosis should be considered in the differential diagnosis of suppurative, regional lymphadenitis, especially in patients who travelled to, or stayed in, an endemic area.
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16/36. Deep neck infection complicating lymphadenitis caused by streptococcus intermedius in an immunocompetent child.

    BACKGROUND: streptococcus intermedius belongs to the streptococcus anginosus group. It is part of the normal flora of the human mouth, but it can be etiologically associated with deep-site infections. CASE PRESENTATION: We present a case of deep neck infection complicating streptococcus intermedius lymphadenitis, which developed in an immunocompetent 14-year-old boy with a history of recent dental work. The infection was ultimately eradicated by a combined medical and surgical approach. CONCLUSION: Our report suggests that combined medical and surgical therapy is essential for the complete resolution of deep infections caused by streptococcus intermedius. Molecular biological techniques can be useful in guiding the diagnostic investigation and providing insight into the possibility of occult abscesses, which are particularly common with streptococcus intermedius infections.
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17/36. Cervical lymphadenitis complicated by mycotic carotid artery aneurysm.

    A case of mycotic carotid artery aneurysm due to cervical lymphadenitis in a four-year old child is presented. Sonography and computed tomography (CT) demonstrated an irregular fluid-containing neck mass, similar in appearance to an uncomplicated abscess. Continuity with the carotid artery was suggested on sonography, and CT demonstrated intense contrast enhancement of the liquid portion of the mass. Mycotic carotid artery aneurysm is a rare, but potentially fatal, complication of cervical lymphadenitis that is detectable with noninvasive diagnostic imaging studies.
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18/36. accessory nerve palsy.

    After apparently uncomplicated excision of benign lesions in the posterior cervical triangle, two patients had shoulder pain. In one, neck pain and trapezius weakness were not prominent until one month after surgery. Inability to elevate the arm above the horizontal without externally rotating it, and prominent scapular displacement on arm abduction, but not on forward pushing movements, highlighted the trapezius dysfunction and differentiated it from serratus anterior weakness. Spinal accessory nerve lesions should be considered when minor surgical procedures, lymphadenitis, minor trauma, or tumours involved the posterior triangle of the neck.
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19/36. The diagnosis of Thornwaldt's cyst.

    Thornwaldt's cyst is an uncommon nasopharyngeal lesion which develops from the remnant of the primitive notochord. A case report of a patient with a Thornwaldt's cyst and cervical adenitis is presented. Though computed tomography of the head and neck was unremarkable, magnetic resonance imaging of the nasopharynx revealed the Thornwaldt's cyst, suggesting that this modality may be more sensitive in detecting and evaluating cystic lesions of the nasopharynx. The differential diagnosis of cystic nasopharyngeal masses is discussed.
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20/36. histiocytic necrotizing lymphadenitis (Kikuchi's disease).

    histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a benign disorder predominantly of young women who present with cervical adenopathy. It has, on occasion, been misdiagnosed as a malignant neoplasm. Little mention of this condition has appeared in the otolaryngologic literature. A patient with Kikuchi's disease is reported and the pertinent literature is reviewed. Because both the clinical and pathological aspects of Kikuchi's disease are important in establishing the diagnosis, effective consultation between the head and neck surgeon and the pathologist is crucial.
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