Head and neck lesions in the immunocompromised host

Abstract

Head and neck lesions are encountered in more than 40-50% in patients with immunosuppression (HIV-infected individuals, diabetes mellitus, transplant recipients, patients treated with immunosuppressive drugs or post-radiotherapy). The organs affected are the salivary glands, the lymph nodes, the sinonasal tract, the orbits, the temporal bones, and the pharyngo-laryngeal mucosa. They are mainly involved by granulation tissue, perivascular and perineural inflammation, and neoplasms. In the pediatric population the temporal bone is the most frequent target organ. The most common clinical manifestation of salivary gland involvement is non-specific bilateral painless enlargement of the parotid gland and xerostomia. Lymphoepithelial cyst, sialosis, and lymphoma may be present. The high rate of salivary gland involvement is probably related to the presence of the human immunodeficiency virus within the saliva. Surgery, sclerotherapy by doxycycline, or low-dose radiotherapy may prevent further growth of tumoral lesions. Sinonasal diseases are the most frequent lesions which manifest in immunosuppressed adult patients (66%). They are associated with a trend of decreased survival rate. Invasive aspergillosis is defined by hyphae in the submucosa, and tumor necrosis without host inflammatory response; it may be lethal in 50-80%, especially when the skull base is involved. Computed tomography shows erosion of bone and extrasinonasal extension. The hypointensity of the lesion on T2-weighted images may suggest the diagnosis. Fungal sinus disease can affect 1-10% of transplant recipients and should be suspected when organ rejection is considered. The temporal bone is the most frequent target organ in the immunosuppressed pediatric population due to Eustachian,tube dysfunction. Otomastoïditis, necrotizing external otitis, and otosyphilis are reported. Prompt treatment may avoid lateral sinus thrombosis. Epithelial neoplasms, lymphomas, and Kaposi's sarcoma may also be considered. Kaposi's sarcoma, the most common neoplasm encountered in patients with AIDS, is an indicator of the progression of human immunodeficiency virus infection to AIDS. The lesions are often multifocal at presentation and may affect the skin, the mucosa, and visceral organs. The pathogenesis is unclear, but cytokines and growth factors may play a role. In conclusion, immunosuppressed patients are likely to develop virulent infection with vascular complications.

Prevalence of human immunodeficiency virus seropositivity in head and neck malignancies in sub-Saharan Africa

“…They reported Kaposi's sarcoma and NHL as the most common lesions, with frequencies of occurrence of 20 000 and 60Á70, respectively, compared with the general population. High rates of salivary gland diseases, not necessarily tumours, were observed by Marsot-Dupuch et al [15], Imogu [16], Nwaorgu et al [17] and Bakari et al [18]. Marsot-Dupuch et al attributed this to a probable increase in HIV concentration in saliva.…”

Lymphoepithelial Cysts of Oral Mucosa: Two Cases in Different Regions

“…Giunta and Cataldo 13) and Buchner and Hansen 7) also observed that these cysts may vary in diameter from 2 to 15 mm. OLCs occurring on the parotid gland are often associated with immunocompromised patients and lymphoproliferative disorders 20) . Table 1 Fig.…”

Vestibular involvement in adults with HIV/AIDS

“…Diseases involving the head and neck area are often the first signs of an immune compromised body and may occur in as many as 40% to 90% of individuals with HIV/AIDS [5][6][7][8][9]. Common HIV/AIDSassociated head and neck pathologies include manifestations in the central nervous system (CNS), the naso-, oro-and laryngopharynx and in the inner ear, that may result in hearing loss and/or vestibular disorders [10][11][12].…”