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Stomatococcus mucilaginosis infection leading to early cervical necrotizing fasciitis
Scientific Posters
plained of intermittent cough and of vomiting of a pedunculated mass from his pharynx which lolled out of his mouth and could be swallowed again. There was no history of dysphonia, dyspnea, or stridor. Results: Indirect laryngoscopy showed no tumor. But coughing revealed a tumor arising from the left aryepiglottic fold which could be pulled out of the left corner of the mouth. Direct laryngoscopy and esophagoscopy revealed the lesion to be a large pedunculated polypoidal mass arising from the left aryepiglottic fold with a size of 10 cm in largest diameter. The mass was reddish in color and soft in consistency with an intact overlying mucosa. The tumor was completely surgically excised by means of microlaryngoscopy. Histological examination confirmed the lesion to be a well-differentiated, lipoma-like liposarcoma whose principal treatment is wide excision. Conclusion: In this case report the presentation, treatment, and prognosis of this rare entity will be discussed. P142 Lateral Sinus Thrombosis Associated with Zoster Sine Herpete James Chan MD (presenter); Richard Bergstrom MD; Donald C Lanza MD MS; John G Oas MD Cleveland Hts OH; Shaker Heights OH; Cleveland OH; Cleveland OH
Objectives: Herpes zoster results from reactivation of the varicella-zoster virus (VZV). Zoster sine herpete (ZSH) is an uncommon manifestation of VZV infection and presents with similar symptoms but without the vesicular rash. We describe an unusual case of lateral sinus thrombosis (LST) that developed during the clinical course of ZSH in the C2 distribution. Methods: Case report and literature review. Results: A 55-year-old woman presented with a 3-day history of left temporal and post-auricular pain, nausea, vomiting, and mild photophobia. She denied otalgia, otorrhea, and hearing loss. Examination revealed hyperesthesia in the left C2 nerve root distribution without evidence of herpetic rash. A CT scan showed minimal fluid in the left mastoid cavity (not mastoiditis) and thrombus within the left lateral and sigmoid dural sinus. MRI and MRA confirmed these findings. Laboratory studies revealed elevated neurotrophic IgG levels to VZV. Hypercoagulable studies were normal. She was subsequently treated with Neurontin, acyclovir, and anti-coagulation. Her symptoms improved and she was discharged 3 days later. Conclusion: LST is generally a complication of middle ear infection. Non-septic LST, however, may result from dehydration, oral contraceptive use, coagulopathy, or thyroid disease. This unusual case raises the suspicion that thrombosis resulted from VZV-associated thrombophlebitis in the ipsilateral cerebral venous sinuses along the second cervical nerve root distribution. A high index of suspicion is necessary
in such cases so that a different treatment course can be identified and anti-viral medication initiated promptly. P143 Stomatococcus Mucilaginosis Infection Leading to Early Cervical Necrotizing Fasciitis Thomas R Lowry MD (presenter); Joseph A Brennan MD San Antonio TX; Boerne TX
Objectives: The goal of this report is to discuss a unique and early presentation of cervical necrotizing fasciitis secondary to a parotid cyst infection with Stomatococcus mucilaginosis in an otherwise healthy adult male patient. Methods: Case report with discussion of current literature. Results: A 24-year-old Caucasian male presented with right neck pain and swelling. Physical examination and CT were consistent with a right parotid gland abscess and cervical cellulitis. Initial antibiotic therapy and surgical intervention failed to reverse the patient’s development of early cervical necrotizing fasciitis due to Stomatococcus mucilaginosis, an infrequent opportunistic microorganism of the oral cavity which only rarely has been implicated in infections of severely immunocompromised patients. The diagnostic evaluation, laboratory results, radiographic findings, and successful treatment outcomes are presented. Conclusion: Necrotizing cervical fasciitis is an aggressive infection with frequent mortality. Although the clinical diagnosis of necrotizing fasciitis is straightforward at an advanced stage, it may be very difficult to differentiate between cellulitis and necrotizing fasciitis at initial presentation. The distinction is crucial, however, because cellulitis responds to antibiotic treatment alone, whereas survival of patients with necrotizing fasciitis depends on early extensive surgical debridement and supportive therapy. Sparse reports of infections due to Stomatococcus mucilaginosis have been seen predominantly in immunocompromised patients with serious underlying disease, yet to our knowledge, this organism has never previously been implicated in salivary gland infections or the development of cervical necrotizing fasciitis. Early aggressive surgical intervention should be considered in these cases even when classic signs of necrotizing fasciitis are not present. P144 Heminasal Proboscis with Associated Microphthalmia and Encephalocele Kofi Derek Owusu Boahene MD (presenter); Dana M Thompson MD Rochester MN; Rochester MN
Objectives: Heminasal proboscis is a rare congenital malformation that presents complex management issues when associated with other craniofacial abnormalities. We present a case associated with microphthalmia and meningoencephalocele.
POSTERS
P258
Otolaryngology– Head and Neck Surgery August 2003
plained of intermittent cough and of vomiting of a pedunculated mass from his pharynx which lolled out of his mouth and could be swallowed again. There was no history of dysphonia, dyspnea, or stridor. Results: Indirect laryngoscopy showed no tumor. But coughing revealed a tumor arising from the left aryepiglottic fold which could be pulled out of the left corner of the mouth. Direct laryngoscopy and esophagoscopy revealed the lesion to be a large pedunculated polypoidal mass arising from the left aryepiglottic fold with a size of 10 cm in largest diameter. The mass was reddish in color and soft in consistency with an intact overlying mucosa. The tumor was completely surgically excised by means of microlaryngoscopy. Histological examination confirmed the lesion to be a well-differentiated, lipoma-like liposarcoma whose principal treatment is wide excision. Conclusion: In this case report the presentation, treatment, and prognosis of this rare entity will be discussed. P142 Lateral Sinus Thrombosis Associated with Zoster Sine Herpete James Chan MD (presenter); Richard Bergstrom MD; Donald C Lanza MD MS; John G Oas MD Cleveland Hts OH; Shaker Heights OH; Cleveland OH; Cleveland OH
Objectives: Herpes zoster results from reactivation of the varicella-zoster virus (VZV). Zoster sine herpete (ZSH) is an uncommon manifestation of VZV infection and presents with similar symptoms but without the vesicular rash. We describe an unusual case of lateral sinus thrombosis (LST) that developed during the clinical course of ZSH in the C2 distribution. Methods: Case report and literature review. Results: A 55-year-old woman presented with a 3-day history of left temporal and post-auricular pain, nausea, vomiting, and mild photophobia. She denied otalgia, otorrhea, and hearing loss. Examination revealed hyperesthesia in the left C2 nerve root distribution without evidence of herpetic rash. A CT scan showed minimal fluid in the left mastoid cavity (not mastoiditis) and thrombus within the left lateral and sigmoid dural sinus. MRI and MRA confirmed these findings. Laboratory studies revealed elevated neurotrophic IgG levels to VZV. Hypercoagulable studies were normal. She was subsequently treated with Neurontin, acyclovir, and anti-coagulation. Her symptoms improved and she was discharged 3 days later. Conclusion: LST is generally a complication of middle ear infection. Non-septic LST, however, may result from dehydration, oral contraceptive use, coagulopathy, or thyroid disease. This unusual case raises the suspicion that thrombosis resulted from VZV-associated thrombophlebitis in the ipsilateral cerebral venous sinuses along the second cervical nerve root distribution. A high index of suspicion is necessary
in such cases so that a different treatment course can be identified and anti-viral medication initiated promptly. P143 Stomatococcus Mucilaginosis Infection Leading to Early Cervical Necrotizing Fasciitis Thomas R Lowry MD (presenter); Joseph A Brennan MD San Antonio TX; Boerne TX
Objectives: The goal of this report is to discuss a unique and early presentation of cervical necrotizing fasciitis secondary to a parotid cyst infection with Stomatococcus mucilaginosis in an otherwise healthy adult male patient. Methods: Case report with discussion of current literature. Results: A 24-year-old Caucasian male presented with right neck pain and swelling. Physical examination and CT were consistent with a right parotid gland abscess and cervical cellulitis. Initial antibiotic therapy and surgical intervention failed to reverse the patient’s development of early cervical necrotizing fasciitis due to Stomatococcus mucilaginosis, an infrequent opportunistic microorganism of the oral cavity which only rarely has been implicated in infections of severely immunocompromised patients. The diagnostic evaluation, laboratory results, radiographic findings, and successful treatment outcomes are presented. Conclusion: Necrotizing cervical fasciitis is an aggressive infection with frequent mortality. Although the clinical diagnosis of necrotizing fasciitis is straightforward at an advanced stage, it may be very difficult to differentiate between cellulitis and necrotizing fasciitis at initial presentation. The distinction is crucial, however, because cellulitis responds to antibiotic treatment alone, whereas survival of patients with necrotizing fasciitis depends on early extensive surgical debridement and supportive therapy. Sparse reports of infections due to Stomatococcus mucilaginosis have been seen predominantly in immunocompromised patients with serious underlying disease, yet to our knowledge, this organism has never previously been implicated in salivary gland infections or the development of cervical necrotizing fasciitis. Early aggressive surgical intervention should be considered in these cases even when classic signs of necrotizing fasciitis are not present. P144 Heminasal Proboscis with Associated Microphthalmia and Encephalocele Kofi Derek Owusu Boahene MD (presenter); Dana M Thompson MD Rochester MN; Rochester MN
Objectives: Heminasal proboscis is a rare congenital malformation that presents complex management issues when associated with other craniofacial abnormalities. We present a case associated with microphthalmia and meningoencephalocele.
POSTERS
P258
Otolaryngology– Head and Neck Surgery August 2003