Pyogenic Granuloma: A New Therapeutic Role for Salt?

Abstract

Pharyngitis with petechiae and exudative palatine tonsillitis are typical manifestations of infectious mononucleosis (IM). Lingual tonsillitis (LT) is an uncommon manifestation of IM. 1,2 We recently encountered a child with LT complicating IM.A 6-year-old boy presented to the emergency department in a hospital in regional New South Wales with a 12-day history of sore throat and fever. On presentation, he had severe odynophagia. His speech had a muffled quality described as being a 'hot potato voice'. He was treated with oral penicillin and a single dose of oral steroids by his general practitioner.He was miserable, febrile and dehydrated with mild tachycardia. Exudative palatine tonsillitis and upper cervical lymphadenitis were seen. No stridor, trismus or breathing difficulty were noted and the rest of the examination was unremarkable.Investigations revealed a leucocytosis with increased neutrophils and lymphocytes, elevated Alanine transaminase and Aspartate aminotransaminase and the Epstein-Barr virus IgM was positive.A lateral airway radiograph showed a rounded soft tissue mass at the base of the tongue markedly narrowing the pharyngeal airway suggestive of enlarged lingual tonsil (Fig. 1).He was treated with analgesia, intravenous fluids, parenteral penicillin and a short course of intravenous and oral steroids. The symptoms gradually resolved over the following 5 days.The clinical, laboratory and radiological features suggested a diagnosis of LT complicating IM.A literature search found only a few case reports of LT complicating IM, one an adolescent who had a palatine tonsillectomy at a younger age. 1,2 We hypothesise LT complicating IM is under-recognised and hence under-reported as it is overshadowed by more obvious palatine tonsillitis.Our case highlights the following: (i) In a child with severe odynophagia and a voice with a muffled quality sometimes described as being a hot potato voice, LT needs to be considered as a differential diagnosis; (ii) in the absence of onsite paediatric otolaryngology services, lateral airway radiograph is helpful in arriving at the diagnosis; and (iii) there is modest evidence that corticosteroids are beneficial in children with acute respiratory obstruction due to tonsillar enlargement in Epstein-Barr virus infection. 3

Lingual Tonsillitis: An Under‐recognised Manifestation of Infectious Mononucleosis

“…However, recurrences are common. 1,3 We report the case of a 7-year-old boy who presented with an erythematous friable papular lesion on the palmar aspect of the fourth finger of the right hand (Fig. 1a).…”

“…1,2 We hypothesise LT complicating IM is under-recognised and hence under-reported as it is overshadowed by more obvious palatine tonsillitis.Our case highlights the following: (i) In a child with severe odynophagia and a voice with a muffled quality sometimes described as being a hot potato voice, LT needs to be considered as a differential diagnosis; (ii) in the absence of onsite paediatric otolaryngology services, lateral airway radiograph is helpful in arriving at the diagnosis; and (iii) there is modest evidence that corticosteroids are beneficial in children with acute respiratory obstruction due to tonsillar enlargement in Epstein-Barr virus infection. 3…”

Case report: Pyogenic granuloma—just salt, a simple and pain‐free treatment

“…technique has been reported in few cases before in the literature with satisfactory results in PGs. 1,3,5 We report a case of a 36-year-old woman who presented a rapidly growing erythematous tumor in the left thumb with recurrent bleeding episodes (Figure 1A). After 6 weeks, the patient attends the dermatological clinic, consulting for nonsurgical and pain-free treatment.…”

“…

Dear EditorPyogenic granuloma (PG), also known as lobular capillary hemangioma or granuloma teleangiectaticum, is a common vascular proliferation that affects the skin and mucous membranes. [1][2][3][4] It affects all ages but is more often in children and young people. 4,5 Although its nature is benign, it is characterized by fast growth and recurrent bleeding periods.

…”