Primary lymphoma of the temporal bone is an unusual finding in clinical practice and bilateral affection is even more rare. To the best of our knowledge, there are no reports of bilateral primary temporal bone lymphoma without middle ear involvement in the English medical literature so far. We report, for the first time, a case of primary lymphoma involving both temporal bones which presented with left-sided infranuclear facial palsy. A combination of contrast enhanced magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) was used to characterize and to map the extent of the lesion, as well as to identify the exact site of facial nerve affection. An excision biopsy and immunohistochemistry revealed diffuse large B-cell non-Hodgkin's lymphoma (DLBCL). Whole body fluorodeoxyglucose (FDG) positron emission tomography-computed tomography study (PET-CT) was performed to stage the disease. The patient was treated with chemotherapy and radiation therapy and is now on regular follow-up. The patient is alive and asymptomatic without disease progression for the last twenty months after initial diagnosis.
Introduction: The novel Coronavirus disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is seen to primarily affect the human respiratory system. Chest CT Severity Score (CTSS) provides a semi quantitative assessment of pulmonary involvement in COVID19 patients. COVID-19 pandemic mitigation measures such as SARS-CoV-2 vaccination are being deployed worldwide. However, with the emerging variants of concern of SARS-CoV-2, a high prevalence of post vaccination breakthrough infections is seen. Aim: To assess the association of CTSS with the vaccination status in a cohort of COVID-19 patients referred to a tertiary diagnostic centre and to evaluate the association of CTSS with other clinical parameters including co-morbidities in these patients. Materials and Methods: This cross-sectional observational study was conducted at a tertiary care diagnostic imaging centre in the city of Pune, Maharashtra, India. Data of 1002 symptomatic, adult patients who underwent chest CT and SARSCoV-2 Reverse Transcription Polymerase Chain Reaction (RTPCR)/Rapid Antigen Test (RAT) laboratory test between March 13, 2021 and June 22, 2021, were collected. COVID-19 reporting and Data System (CO-RADS) categories and the corresponding semi quantitative CTSS were calculated for each patient. Based on their vaccination status, patients were categorised into three groups: unvaccinated, partially vaccinated and fully vaccinated. The association of CTSS with various categories of vaccination status, demographics, co-morbidities and stages of the disease of the patients, was evaluated. Results: Of the 1002 COVID-19 patients, 768 (76.6%) were unvaccinated, 190 (19.0%) were partially vaccinated and 44 (4.4%) were fully vaccinated. Mean CTSS in the fully vaccinated cohort was significantly lower (3.75±4.7) than that in the partially vaccinated (6.05±5.7) and unvaccinated (8.29±4.9) patients (mean 3.75 vs. 6.05 vs. 8.29, respectively; (p<0.05). Mean CTSS in patients with no co-morbidities was significantly lower than that in patients with hypertension and diabetes (7.12 vs. 8.75 vs. 10.39, respectively; (p<0.05). Conclusion: Significant association was noted between the Chest CTSS and the vaccination status, age, gender, co-morbidities and stage of disease in this large cohort of COVID-19 patients. The study reiterates that full vaccination aids in reducing the severity of lung involvement in COVID-19 infection.
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