Retropharyngeal abscess (RPA) is an uncommon condition with the potential for significant morbidity and mortality if not detected early. The authors present a case report of a 19-month-old child who presented with the common clinical features of a retropharyngeal abscess and in whom the diagnosis was not established by examination and ultrasonography. This led to a delay in appropriate management until a computed tomography (CT) scan was performed under general anaesthesia. The scan demonstrated the diagnosis and surgical drainage was performed under the same anaesthetic. The child subsequently made a complete recovery. The investigation and treatment of RPAs is a matter of some debate and the authors review the recent literature to determine the best management strategy.
A 17 year old girl with active Crohn's colitis developed idiopathic thrombocytopenic purpura that was managed with intravenous immune globulins and cyclosporin A. The possible association between Crohn's disease and immune thrombocytopenia is explored. (Postgrad Med J 2000;76:299-300) Keywords: Crohn's disease; colitis; thrombocytopenia Various autoimmune diseases have been associated with inflammatory bowel disease, with the majority of reports describing clustering of autoimmune haemolytic anaemia 1 with ulcerative colitis. An unusual case of Crohn's colitis with the subsequent development of idiopathic thrombocytopenic purpura (ITP) is described. Case reportA 17 year old girl with a history of Crohn's pancolitis without ileal involvement since age 8, was relatively well until the age of 16, when she had several hospitalisations for exacerbations of her Crohn's disease. This necessitated a medical regimen of prednisone (30 mg/day), azathioprine (100 mg/day), metronidazole, and mesalamine but the symptoms of colitis persisted.Apart from an anaemia of chronic disease (packed cell volume 0.247), her blood counts were normal until May 1996 when her platelet count was 3 × 10 9 /l, haemoglobin 85 g/l, packed cell volume 0.258, and leucocyte count 9.2 × 10 9 /l. She was also experiencing epistaxis and bloody diarrhoea. She had no history of recent viral infections, immunisations, recent blood transfusions, or use of recreational drugs. Physical examination revealed only mild cushingoid facies and there was no hepatosplenomegaly. Erythrocyte sedimentation rate was 60 mm/hour. Antinuclear antibodies, anti-HIV, Coombs' tests, platelet associated IgG, white cell diVerential, partial thromboplastin time, and prothrombin time were unremarkable. A peripheral blood smear showed marked thrombocytopenia with occasional giant platelets and no evidence of microangiopathic haemolytic anaemia. A bone marrow biopsy specimen revealed normocellularity with megakaryocytic hyperplasia compatible with peripheral platelet destruction.The patient's medications were discontinued and she was managed initially with methylprednisone (2 mg/kg/day) and platelet transfusions but without eVect. She was then treated with intravenous gammaglobulin (1 g/kg/day) which raised her platelet count to 45 × 10 9 /l and maintained on cyclosporin A (5 mg/kg/day) and prednisone (60 mg/day) as an outpatient. Her platelet counts remained between 400 and 680 × 10 9 /l. A colonoscopy, one month after discharge, revealed no active Crohn's disease. However, two months later, the return of active colitis prompted the addition of mesalamine to her regimen. One month later, she developed an inflammatory colonic mass necessitating left hemicolectomy. Histology of the mass was consistent with severely active Crohn's colitis. She remained asymptomatic, with normal platelet counts and did not require immunosuppressive medication. DiscussionThere are multiple case reports in the literature describing the association of inflammatory bowel disease with extraintest...
Following the reports of a cluster of meningitis cases in recently implanted patients the FDA issued cautionary advice relating to the risk of meningitis after cochlear implantation (US Food and Drug Administration, 2002). Similar advice and a national reporting call has been issued by the Department of Health in the UK (Medical Devices Agency, 2002) and universal prophylactic pneumococcal vaccination started. We present a case of bilateral Mondini-type dysplasia associated with a defective stapes footplate and highlight the need for surgical vigilance to reduce the risks of meningitis from undiagnosed anatomical defects.
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