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"cabecera" => "<span class="elsevierStyleTextfn">Case Study</span>" "titulo" => "Perforating Pilomatricoma Presenting as an Ulcer in the Helix of the Pinna" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "359" "paginaFinal" => "361" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perforantes pilomatricomas presentación como una úlcera en el Helix del Pinna" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 605 "Ancho" => 1300 "Tamanyo" => 310019 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Histopathology shows aggregate of 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Hyper-intense lesion with diffuse edges located on the floor of the mouth.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Study</span><p id="par0005" class="elsevierStylePara elsevierViewall">Female, 22 years old, presenting swelling with inflammatory characteristics in the supra-hyoid region. Approximately 2 months earlier, the patient had been diagnosed as having a left peri-amygdaline abscess, with spontaneous drainage of purulent content. She did not present any other relevant medical or surgical history.</p><p id="par0010" class="elsevierStylePara elsevierViewall">On questioning, the patient did not report any dyspnoea, dysphonia, dysphagia, coughing nor any other symptom in the otorhinolaryngological area.</p><p id="par0015" class="elsevierStylePara elsevierViewall">During the physical examination, a hard mass with imprecise limits was observed in the supra-hyoid region. The examination of the oral and oropharyngeal cavity did not reveal any significant findings. No cervical adenopathies were palpated.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In view of the clinical suspicion of an infectious or inflammatory process, the patient was treated empirically with amoxicillin and zx clavulanic acid, without improvement and with a gradual increase in the size of the lesion.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Magnetic resonance imaging (MRI) revealed a soft tissue mass measuring 4<span class="elsevierStyleHsp" style=""></span>cm in diameter that imprecisely distorted the soft planes of the supra-hyoid region and extended into the sub-mandibular and sub-lingual spaces. Following administration of contrast, homogeneous highlighting of the entire area could be appreciated without any capsule being defined (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The FNB of the mass was reported as an inflammatory lesion with neutrophils and macrophages. Isolated groups of zx non-ciliate columnar cells were observed to present reactive atypia.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In view of the poor evolution despite medical treatment, it was decided to perform an exploratory cervicotomy, during which a non-infiltrative supra-hyoid swelling was found on the surface of the zx milo-hyoid muscle, and had a necrotic centre. The cavity was opened and its entire content drained.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The histopathological study revealed the presence of non-specific chronic inflammation of soft tissue, with the presence of abundant capillary vascularization, oedema and plasmatic cells with abundant macrophages, without granulomas or signs of malignancy.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The culture identified the presence of β-lactamate sensitive <span class="elsevierStyleItalic">Eikenella corrodens (E. corrodens)</span>. The mycobacterial culture was negative.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient was treated with zx cefditoren-pivoxilo 400<span class="elsevierStyleHsp" style=""></span>mg every 24<span class="elsevierStyleHsp" style=""></span>h for 10 days, with good progress and resolution of the cervical lesion.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E. corrodens</span> is a zx opportunistic facultative? Gram-negative anaerobic zx coccobacillus, that only grows with difficulty. It is habitually found in the oral, gastrointestinal and genito-urinary flora. Its role as a pathogenic agent has been increasingly recognized as it is a causal agent for a wide variety of infections.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> It acts as an opportunistic pathogen in both immune-compromised and immune-competent patients. As its culture, isolation and identification may be complex, suspected diagnoses and a meticulous microbiological study are important.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the head and neck area, <span class="elsevierStyleItalic">E. corrodens</span> generally affects zx immune-competent individuals,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> and its focus is the oral and oropharyngeal cavity.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,5</span></a> In the amygdaline region, it may be located in deep zx crypts, thus hindering the taking of samples. It is normally found in polymicrobial infections, where <span class="elsevierStyleItalic">Streptococcus</span> and <span class="elsevierStyleItalic">Staphylococcus</span> can increase its pathogenicity.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In adolescents and under certain favourable conditions, <span class="elsevierStyleItalic">E. corrodens</span> may cause abscesses, disseminated infections and septic zx cuadros.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> The case reported here involved a young girl with a history of a peri-amygdaline abscess, which may have been the cause of the zx cuadro.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Treatment is based on the use of antibiotics and also surgery in the vast majority of cases.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Despite being a bacterium that resides in the oropharynx, it is resistant to habitually used drugs such as clindamycin, metronidazole and penicillinase-resistant penicillins.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> It is sensitive to benzylpenicillins, third-generation cephalosporins, amoxicillin and clavulanic acid, cotrimoxazole and fluorokinolones, and presents relative resistance to aminoglucosides and erythromycin. The treatment of choice involves third-generation cephalosporins, the new fluorokinolones or zx carbapenems.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The surgical drainage of the purulent content is fundamental to achieve a favourable outcome. In the study reported by Paul and Patel,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> 90% of the cases identified required one or more zx interventions to bring the infection under control, even in cases with correctly prescribed antibiotics.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion, <span class="elsevierStyleItalic">E. corrodens</span> can cause infections in the head and neck area of immunocompetent patients. The amygdalar area is the most frequent origin. Clinical zx suspicion and adequate culture are fundamental for its diagnosis. Third-generation zx cephalosporins and surgical drainage where necessary constitute the treatment of choice.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Study" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-01-29" "fechaAceptado" => "2014-04-16" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rivas Castillo FJ, Gómez Martinez JR, López Álvarez F, García Velasco F. Infección cervical profunda causada por <span class="elsevierStyleItalic">Eikenella corrodens</span>. Acta Otorrinolaringol Esp. 2015;66:e33–e34.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 798 "Ancho" => 800 "Tamanyo" => 80759 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sagittal T1-weighted MRI slice with gadolinium contrast. A poorly defined hyper-intense mass of soft tissue can be seen to affect the supra-hyoid region and compromises the floor of the mouth and the extrinsic muscles of the tongue.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 947 "Ancho" => 800 "Tamanyo" => 78977 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Axial MRI diffusion slice. Hyper-intense lesion with diffuse edges located on the floor of the mouth.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Eikenella corrodens:</span> An unexpected pathogen causing a persistent peritonsillar abscess" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.D. Knudsen" 1 => "E.J. 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Journal Information
Vol. 66. Issue 6.
Pages e33-e34 (November - December 2015)
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Vol. 66. Issue 6.
Pages e33-e34 (November - December 2015)
Case study
Eikenella corrodens: A Rare Cause of Deep Neck Infection
Infección cervical profunda causada por Eikenella corrodens
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Fernando Javier Rivas Castillo
, Justo Ramón Gómez Martinez, Fernando López Álvarez, Fabián García Velasco
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Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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