Gerson Maahs - Academia.edu (original) (raw)
Papers by Gerson Maahs
International Archives of Otorhinolaryngology, Sep 30, 2023
Introduction Sensory deficits of the upper airways are common in people with Parkinson disease. C... more Introduction Sensory deficits of the upper airways are common in people with Parkinson disease. Compounded by considerable deterioration of the swallowing function, these deficits may contribute to the elevated rates of morbidity and mortality among this population. Objective To examine the sensitivity of the vocal tracts of people with Parkinson disease using nasal videoendoscopy and to compare the results with paired controls. Methods The present was a prospective, observational, case-control study. Sensitivity assessments were conducted in a sample of 24 people divided into 2 groups: one group of 12 patients with Parkinson's disease, and a control group with 12 healthy subjects. The study group also underwent a fiberoptic endoscopic evaluation of swallowing and answered the Swallowing Disturbance Questionnaire (SQD) to detect dysphagia. Results There was a significant difference (p < 0.05) in the region of the arytenoid cartilages, showing that sensitivity was better preserved among the control group, and that sensitivity deficits were present in the study group. The qualitative results showed sensorial impairment in the study group than in the control group regarding the base of the tongue, the vestibular folds, and the vocal folds. The study group showed selfawareness regarding the deficits in the swallowing function, but there was no statistically significant association between swallowing function deficits and deterioration of sensorial function among them. Conclusions Sensorial deficits were present in the study group when compared to the healthy subjects, mainly in the qualitative evaluation.
Paraganglioma de corPo carotídeo com abaulamento de orofaringe-relato de caso Carotid body paraga... more Paraganglioma de corPo carotídeo com abaulamento de orofaringe-relato de caso Carotid body paraganglioma with bulging oropharynx
Revista Brasileira de Neurologia, Oct 30, 2018
The primary purpose of this study was to investigate the effect of dual-tasking on swallowing per... more The primary purpose of this study was to investigate the effect of dual-tasking on swallowing performance and attention in patients with Parkinson Disease (PD). Twenty six participants were included, thirteen patients with PD and thirteen controls matched by age and education. All subjects were evaluated at single swallowing task and attentional dual-tasking. Swallowing parameters were analyzed by using Fiberoptic Endoscopic Evaluation Swallowing Safety Study (FEESS). The attentional dual-tasking was realized using an adaptation of "Stroop color test" on video. Images about swallowing parameters in both conditions were analyzed by three experienced evaluators using literature definitions. Both groups underwent cognitive screening using MoCA. Although significant difference between swallowing parameters in both conditions were not found, in PD group there was an association between changes in parameters according to graduation and cognitive performance. The results show the dual-tasking influence worsening in PD patients with low scores on cognitive screening and low graduation. The results suggest more attention to PD patients that have worse cognitive status and / or low levels of education as the worsening of dysphagia and aspiration risk in performing dual-tasks to feed themselves.
Agradeço aos meus colegas do curso de doutorado pela convivência afetiva, pelo estímulo e solidar... more Agradeço aos meus colegas do curso de doutorado pela convivência afetiva, pelo estímulo e solidariedade durante as disciplinas cursadas. Aos professores que atuaram de forma profissional, séria e estimulante para o objetivo de ensinar. Ao meu orientador, professor Dr. Gustavo Carvalhal que de forma serena objetivou esta tese. Ao professor Vinícius Duval da Silva que disponibilizou o equipamento e foi mestre no ensino para a leitura dos resultados. Ao Dr. Mario Wagner, pelas sugestões e auxílio na análise estatística. Às funcionárias da Pós-Graduação em Medicina, Sônia e Eloá, sempre zelosas no auxílio aos trâmites administrativos. Ao médico patologista Dr. Jorge Zanol e aos Serviços de Patologia e Estomatologia do Hospital São Lucas da PUCRS por disponibilizar o material de minha pesquisa. Aos meus amigos e colegas médicos pelo estímulo e solidariedade. Aos meus pacientes que a sua saúde me confiaram.
Ear, nose, & throat journal, Jun 6, 2019
A 17-year-old male was admitted to hospital for fever, right periorbital edema, purulent rhinorrh... more A 17-year-old male was admitted to hospital for fever, right periorbital edema, purulent rhinorrhea, and nasal obstruction for 3 days (Figure 1A). He had been under treatment with antibiotic and corticoid for rhinosinusitis, with no improvement. Previous surgery was performed 6 months before for ''nasal polyposis.'' The anatomopathological (AP) highlighted polypoid inflammatory mucosa. Upon examination, he presented with peripalpebral edema on the right, conjunctival hyperemia with preserved ocular mobility and visual acuity and painless subcutaneous nodules on the right hemiface. Nasoendoscopy showed no changes in the left or nasopharynx; in the right, edema and mucosa hyperemia obstructing the upper airway and purulent rhinorrhea. Contrast computerized tomography (CT) of sinuses and orbit revealed extraconal infiltrating and expanding injury compromising orbit and right periorbit, with eyeball proptosis; maxillary, sphenoid sinus, ethmoidal cells, frontal sinus, and nasolacrimal duct were obliterated; and infiltration of the skin and subcutaneous on the right was identified (Figure 1B and C). Abdomen CT revealed splenomegaly (15.5 cm). Pelvis and chest CT were normal. Serologies, rheumatic tests, hemoculture, uroculture, and Mantoux were negative. During admission, cefepime was commenced for febrile neutropenia. Biopsy of the lesion via nasal endoscopy in the right nasal cavity was performed with Epstein-Barr virus (EBV) checking positive. There was not enough material for diagnosis through immunohistochemistry due to the large amount of necrotic material. There was a gradual worsening of pancytopenia, increase in lactate dehydronagenase (LDH), and episode of right severe epistaxis, which was controlled with nasal packing. Bone marrow biopsy was carried out due to the suspicion of lymphoma, with negative result. Prednisone was initiated in lower doses, and new biopsy of the lesion in the right nasal cavity was performed through lateral rhinotomy, anatomopathology examination identified lymphoma. Extranodal natural killer /T-cell lymphoma, nasal type (ENKL) was confirmed by immunohistochemistry. Treatment with radiotherapy and outpatient chemotherapy was commenced.
Brazilian Journal of Otorhinolaryngology, Sep 1, 2007
Oral Diseases, Jul 28, 2021
BACKGROUND Photobiomodulation therapy (PBMT) is an effective method for the prevention of oral mu... more BACKGROUND Photobiomodulation therapy (PBMT) is an effective method for the prevention of oral mucositis. However, the effects of PBMT on oral squamous cell carcinoma (OSCC) have not yet been fully elucidated. This study aimed to evaluate the impact of PBMT in an OSCC-patient-derived xenograft (OSCC-PDX) model. METHODS BALB/c nude mice with OSCC-PDX models were divided into Control, without PBMT (n=8); Immediate irradiation, PBMT since one week after tumor implantation (n=6); and Late irradiation, PBMT after tumors reached 200mm3 (n=6). OSCC-PDX were daily irradiated (660nm; 100mW; 6J/cm2 ; 0,2J/point) for 12 weeks. The tumors were collected and submitted to volumetric, histological, immunohistochemistry, and cell cycle analysis. RESULTS No significant differences in the volumetric measurements (p=0.89) and in the histopathological grade (p>0.05) were detected between the groups. The immunohistochemical analysis of Ki-67 (p=0.9661); H3K9ac (p=0.3794); and BMI1 (p=0.5182), and the evaluation of the cell cycle phases (p>0.05) by flow cytometry also did not demonstrate significant differences between the irradiated and non-irradiated groups. CONCLUSION In this study, PBMT did not impact the behavior of OSCC-PDX models. This is an important preclinical outcome regarding safety concerns of the use of PBMT in cancer patients.
Brazilian Journal of Otorhinolaryngology, May 1, 2015
Introduction: Benign tumors of the parotid gland comprise the majority of salivary gland tumors. ... more Introduction: Benign tumors of the parotid gland comprise the majority of salivary gland tumors. Objective: To review the clinical characteristics of parotid gland tumors submitted to surgical treatment by the same surgeon. Methods: Retrospective study with 154 patients who had parotid gland tumors. Clinical and histological data, type of surgery, and complications were assessed and described. Results: The main manifestation was a mass with a median evolution of 12 months for benign tumors and five months for malignant tumors. Ultrasonography was the most frequent complementary exam. Pleomorphic adenoma was the most common of the benign tumors, and mucoepidermoid carcinoma was the most frequent malignant tumor. Superficial parotidectomy with preservation of the facial nerve was the most common surgical procedure and reversible paresis of branches of the facial nerve was the most common complication. Conclusions: Pleomorphic adenoma is the most common parotid gland tumor and superficial parotidectomy with preservation of the facial nerve is the most common and appropriate treatment for most low-morbidity tumors.
Revista de Ciências Médicas e Biológicas, Nov 7, 2019
Resumo Introdução: a síndrome da apneia obstrutiva do sono (SAOS) caracteriza-se por episódios re... more Resumo Introdução: a síndrome da apneia obstrutiva do sono (SAOS) caracteriza-se por episódios recorrentes de obstrução parcial ou total da via aérea superior, normalmente acompanhada por roncos. É de etiologia multifatorial, e o diagnóstico leva em consideração os fatores de risco e as comorbidades. Objetivo: estudar os fatores de risco da SAOS, devido às comorbidades e às consequências graves que podem estar relacionadas à patologia, visando a atuar em sua prevenção e tratamento. Revisão de literatura: os principais fatores de risco encontrados foram: obesidade, circunferência cervical maior que 40 cm, IMC aumentado, histórico familiar, sexo masculino, meia-idade, Classe III e IV de Mallampati modificada e alterações nas vias aéreas superiores como desvio de septo nasal, palato mole rebaixado e posteriorizado e alterações craniofaciais. Metodologia: realizou-se uma revisão de literatura sobre os fatores de risco da SAOS, utilizando-se as bases de dados Pubmed, Scielo e Medline e os descritores de busca de acordo com os DECs ou Mesh. Conclusão: o estudo dos fatores de risco associados à presença de SAOS demonstra a necessidade da abordagem interdisciplinar dessa patologia junto ao médico otorrinolaringologista, por ser ela multifatorial. Palavras-chave: Apneia Obstrutiva do Sono. Fatores de risco. Síndrome da Apneia do Sono.
Ortodontia Gaúcha, Nov 23, 2009
The primary purpose of this study was to investigate the effect of dualtasking on swallowing perf... more The primary purpose of this study was to investigate the effect of dualtasking on swallowing performance and attention in patients with Parkinson Disease (PD). Twenty six participants were included, thirteen patients with PD and thirteen controls matched by age and education. All subjects were evaluated at single swallowing task and attentional dual-tasking. Swallowing parameters were analyzed by using Fiberoptic Endoscopic Evaluation Swallowing Safety Study (FEESS). The attentional dual-tasking was realized using an adap-tation of “Stroop color test” on video. Images about swallowing pa-rameters in both conditions were analyzed by three experienced evaluators using literature definitions. Both groups underwent cog-nitive screening using MoCA. Although significant difference between swallowing parameters in both conditions were not found, in PD group there was an association between changes in parameters ac-cording to graduation and cognitive performance. The results show the dual-t...
Ear, Nose & Throat Journal, 2019
A 17-year-old male was admitted to hospital for fever, right periorbital edema, purulent rhinorrh... more A 17-year-old male was admitted to hospital for fever, right periorbital edema, purulent rhinorrhea, and nasal obstruction for 3 days (Figure 1A). He had been under treatment with antibiotic and corticoid for rhinosinusitis, with no improvement. Previous surgery was performed 6 months before for ''nasal polyposis.'' The anatomopathological (AP) highlighted polypoid inflammatory mucosa. Upon examination, he presented with peripalpebral edema on the right, conjunctival hyperemia with preserved ocular mobility and visual acuity and painless subcutaneous nodules on the right hemiface. Nasoendoscopy showed no changes in the left or nasopharynx; in the right, edema and mucosa hyperemia obstructing the upper airway and purulent rhinorrhea. Contrast computerized tomography (CT) of sinuses and orbit revealed extraconal infiltrating and expanding injury compromising orbit and right periorbit, with eyeball proptosis; maxillary, sphenoid sinus, ethmoidal cells, frontal sinus, and nasolacrimal duct were obliterated; and infiltration of the skin and subcutaneous on the right was identified (Figure 1B and C). Abdomen CT revealed splenomegaly (15.5 cm). Pelvis and chest CT were normal. Serologies, rheumatic tests, hemoculture, uroculture, and Mantoux were negative. During admission, cefepime was commenced for febrile neutropenia. Biopsy of the lesion via nasal endoscopy in the right nasal cavity was performed with Epstein-Barr virus (EBV) checking positive. There was not enough material for diagnosis through immunohistochemistry due to the large amount of necrotic material. There was a gradual worsening of pancytopenia, increase in lactate dehydronagenase (LDH), and episode of right severe epistaxis, which was controlled with nasal packing. Bone marrow biopsy was carried out due to the suspicion of lymphoma, with negative result. Prednisone was initiated in lower doses, and new biopsy of the lesion in the right nasal cavity was performed through lateral rhinotomy, anatomopathology examination identified lymphoma. Extranodal natural killer /T-cell lymphoma, nasal type (ENKL) was confirmed by immunohistochemistry. Treatment with radiotherapy and outpatient chemotherapy was commenced.
Rev Bras Reumatol, Aug 1, 2002
International Archives of Otorhinolaryngology, Sep 30, 2023
Introduction Sensory deficits of the upper airways are common in people with Parkinson disease. C... more Introduction Sensory deficits of the upper airways are common in people with Parkinson disease. Compounded by considerable deterioration of the swallowing function, these deficits may contribute to the elevated rates of morbidity and mortality among this population. Objective To examine the sensitivity of the vocal tracts of people with Parkinson disease using nasal videoendoscopy and to compare the results with paired controls. Methods The present was a prospective, observational, case-control study. Sensitivity assessments were conducted in a sample of 24 people divided into 2 groups: one group of 12 patients with Parkinson's disease, and a control group with 12 healthy subjects. The study group also underwent a fiberoptic endoscopic evaluation of swallowing and answered the Swallowing Disturbance Questionnaire (SQD) to detect dysphagia. Results There was a significant difference (p < 0.05) in the region of the arytenoid cartilages, showing that sensitivity was better preserved among the control group, and that sensitivity deficits were present in the study group. The qualitative results showed sensorial impairment in the study group than in the control group regarding the base of the tongue, the vestibular folds, and the vocal folds. The study group showed selfawareness regarding the deficits in the swallowing function, but there was no statistically significant association between swallowing function deficits and deterioration of sensorial function among them. Conclusions Sensorial deficits were present in the study group when compared to the healthy subjects, mainly in the qualitative evaluation.
Paraganglioma de corPo carotídeo com abaulamento de orofaringe-relato de caso Carotid body paraga... more Paraganglioma de corPo carotídeo com abaulamento de orofaringe-relato de caso Carotid body paraganglioma with bulging oropharynx
Revista Brasileira de Neurologia, Oct 30, 2018
The primary purpose of this study was to investigate the effect of dual-tasking on swallowing per... more The primary purpose of this study was to investigate the effect of dual-tasking on swallowing performance and attention in patients with Parkinson Disease (PD). Twenty six participants were included, thirteen patients with PD and thirteen controls matched by age and education. All subjects were evaluated at single swallowing task and attentional dual-tasking. Swallowing parameters were analyzed by using Fiberoptic Endoscopic Evaluation Swallowing Safety Study (FEESS). The attentional dual-tasking was realized using an adaptation of "Stroop color test" on video. Images about swallowing parameters in both conditions were analyzed by three experienced evaluators using literature definitions. Both groups underwent cognitive screening using MoCA. Although significant difference between swallowing parameters in both conditions were not found, in PD group there was an association between changes in parameters according to graduation and cognitive performance. The results show the dual-tasking influence worsening in PD patients with low scores on cognitive screening and low graduation. The results suggest more attention to PD patients that have worse cognitive status and / or low levels of education as the worsening of dysphagia and aspiration risk in performing dual-tasks to feed themselves.
Agradeço aos meus colegas do curso de doutorado pela convivência afetiva, pelo estímulo e solidar... more Agradeço aos meus colegas do curso de doutorado pela convivência afetiva, pelo estímulo e solidariedade durante as disciplinas cursadas. Aos professores que atuaram de forma profissional, séria e estimulante para o objetivo de ensinar. Ao meu orientador, professor Dr. Gustavo Carvalhal que de forma serena objetivou esta tese. Ao professor Vinícius Duval da Silva que disponibilizou o equipamento e foi mestre no ensino para a leitura dos resultados. Ao Dr. Mario Wagner, pelas sugestões e auxílio na análise estatística. Às funcionárias da Pós-Graduação em Medicina, Sônia e Eloá, sempre zelosas no auxílio aos trâmites administrativos. Ao médico patologista Dr. Jorge Zanol e aos Serviços de Patologia e Estomatologia do Hospital São Lucas da PUCRS por disponibilizar o material de minha pesquisa. Aos meus amigos e colegas médicos pelo estímulo e solidariedade. Aos meus pacientes que a sua saúde me confiaram.
Ear, nose, & throat journal, Jun 6, 2019
A 17-year-old male was admitted to hospital for fever, right periorbital edema, purulent rhinorrh... more A 17-year-old male was admitted to hospital for fever, right periorbital edema, purulent rhinorrhea, and nasal obstruction for 3 days (Figure 1A). He had been under treatment with antibiotic and corticoid for rhinosinusitis, with no improvement. Previous surgery was performed 6 months before for ''nasal polyposis.'' The anatomopathological (AP) highlighted polypoid inflammatory mucosa. Upon examination, he presented with peripalpebral edema on the right, conjunctival hyperemia with preserved ocular mobility and visual acuity and painless subcutaneous nodules on the right hemiface. Nasoendoscopy showed no changes in the left or nasopharynx; in the right, edema and mucosa hyperemia obstructing the upper airway and purulent rhinorrhea. Contrast computerized tomography (CT) of sinuses and orbit revealed extraconal infiltrating and expanding injury compromising orbit and right periorbit, with eyeball proptosis; maxillary, sphenoid sinus, ethmoidal cells, frontal sinus, and nasolacrimal duct were obliterated; and infiltration of the skin and subcutaneous on the right was identified (Figure 1B and C). Abdomen CT revealed splenomegaly (15.5 cm). Pelvis and chest CT were normal. Serologies, rheumatic tests, hemoculture, uroculture, and Mantoux were negative. During admission, cefepime was commenced for febrile neutropenia. Biopsy of the lesion via nasal endoscopy in the right nasal cavity was performed with Epstein-Barr virus (EBV) checking positive. There was not enough material for diagnosis through immunohistochemistry due to the large amount of necrotic material. There was a gradual worsening of pancytopenia, increase in lactate dehydronagenase (LDH), and episode of right severe epistaxis, which was controlled with nasal packing. Bone marrow biopsy was carried out due to the suspicion of lymphoma, with negative result. Prednisone was initiated in lower doses, and new biopsy of the lesion in the right nasal cavity was performed through lateral rhinotomy, anatomopathology examination identified lymphoma. Extranodal natural killer /T-cell lymphoma, nasal type (ENKL) was confirmed by immunohistochemistry. Treatment with radiotherapy and outpatient chemotherapy was commenced.
Brazilian Journal of Otorhinolaryngology, Sep 1, 2007
Oral Diseases, Jul 28, 2021
BACKGROUND Photobiomodulation therapy (PBMT) is an effective method for the prevention of oral mu... more BACKGROUND Photobiomodulation therapy (PBMT) is an effective method for the prevention of oral mucositis. However, the effects of PBMT on oral squamous cell carcinoma (OSCC) have not yet been fully elucidated. This study aimed to evaluate the impact of PBMT in an OSCC-patient-derived xenograft (OSCC-PDX) model. METHODS BALB/c nude mice with OSCC-PDX models were divided into Control, without PBMT (n=8); Immediate irradiation, PBMT since one week after tumor implantation (n=6); and Late irradiation, PBMT after tumors reached 200mm3 (n=6). OSCC-PDX were daily irradiated (660nm; 100mW; 6J/cm2 ; 0,2J/point) for 12 weeks. The tumors were collected and submitted to volumetric, histological, immunohistochemistry, and cell cycle analysis. RESULTS No significant differences in the volumetric measurements (p=0.89) and in the histopathological grade (p>0.05) were detected between the groups. The immunohistochemical analysis of Ki-67 (p=0.9661); H3K9ac (p=0.3794); and BMI1 (p=0.5182), and the evaluation of the cell cycle phases (p>0.05) by flow cytometry also did not demonstrate significant differences between the irradiated and non-irradiated groups. CONCLUSION In this study, PBMT did not impact the behavior of OSCC-PDX models. This is an important preclinical outcome regarding safety concerns of the use of PBMT in cancer patients.
Brazilian Journal of Otorhinolaryngology, May 1, 2015
Introduction: Benign tumors of the parotid gland comprise the majority of salivary gland tumors. ... more Introduction: Benign tumors of the parotid gland comprise the majority of salivary gland tumors. Objective: To review the clinical characteristics of parotid gland tumors submitted to surgical treatment by the same surgeon. Methods: Retrospective study with 154 patients who had parotid gland tumors. Clinical and histological data, type of surgery, and complications were assessed and described. Results: The main manifestation was a mass with a median evolution of 12 months for benign tumors and five months for malignant tumors. Ultrasonography was the most frequent complementary exam. Pleomorphic adenoma was the most common of the benign tumors, and mucoepidermoid carcinoma was the most frequent malignant tumor. Superficial parotidectomy with preservation of the facial nerve was the most common surgical procedure and reversible paresis of branches of the facial nerve was the most common complication. Conclusions: Pleomorphic adenoma is the most common parotid gland tumor and superficial parotidectomy with preservation of the facial nerve is the most common and appropriate treatment for most low-morbidity tumors.
Revista de Ciências Médicas e Biológicas, Nov 7, 2019
Resumo Introdução: a síndrome da apneia obstrutiva do sono (SAOS) caracteriza-se por episódios re... more Resumo Introdução: a síndrome da apneia obstrutiva do sono (SAOS) caracteriza-se por episódios recorrentes de obstrução parcial ou total da via aérea superior, normalmente acompanhada por roncos. É de etiologia multifatorial, e o diagnóstico leva em consideração os fatores de risco e as comorbidades. Objetivo: estudar os fatores de risco da SAOS, devido às comorbidades e às consequências graves que podem estar relacionadas à patologia, visando a atuar em sua prevenção e tratamento. Revisão de literatura: os principais fatores de risco encontrados foram: obesidade, circunferência cervical maior que 40 cm, IMC aumentado, histórico familiar, sexo masculino, meia-idade, Classe III e IV de Mallampati modificada e alterações nas vias aéreas superiores como desvio de septo nasal, palato mole rebaixado e posteriorizado e alterações craniofaciais. Metodologia: realizou-se uma revisão de literatura sobre os fatores de risco da SAOS, utilizando-se as bases de dados Pubmed, Scielo e Medline e os descritores de busca de acordo com os DECs ou Mesh. Conclusão: o estudo dos fatores de risco associados à presença de SAOS demonstra a necessidade da abordagem interdisciplinar dessa patologia junto ao médico otorrinolaringologista, por ser ela multifatorial. Palavras-chave: Apneia Obstrutiva do Sono. Fatores de risco. Síndrome da Apneia do Sono.
Ortodontia Gaúcha, Nov 23, 2009
The primary purpose of this study was to investigate the effect of dualtasking on swallowing perf... more The primary purpose of this study was to investigate the effect of dualtasking on swallowing performance and attention in patients with Parkinson Disease (PD). Twenty six participants were included, thirteen patients with PD and thirteen controls matched by age and education. All subjects were evaluated at single swallowing task and attentional dual-tasking. Swallowing parameters were analyzed by using Fiberoptic Endoscopic Evaluation Swallowing Safety Study (FEESS). The attentional dual-tasking was realized using an adap-tation of “Stroop color test” on video. Images about swallowing pa-rameters in both conditions were analyzed by three experienced evaluators using literature definitions. Both groups underwent cog-nitive screening using MoCA. Although significant difference between swallowing parameters in both conditions were not found, in PD group there was an association between changes in parameters ac-cording to graduation and cognitive performance. The results show the dual-t...
Ear, Nose & Throat Journal, 2019
A 17-year-old male was admitted to hospital for fever, right periorbital edema, purulent rhinorrh... more A 17-year-old male was admitted to hospital for fever, right periorbital edema, purulent rhinorrhea, and nasal obstruction for 3 days (Figure 1A). He had been under treatment with antibiotic and corticoid for rhinosinusitis, with no improvement. Previous surgery was performed 6 months before for ''nasal polyposis.'' The anatomopathological (AP) highlighted polypoid inflammatory mucosa. Upon examination, he presented with peripalpebral edema on the right, conjunctival hyperemia with preserved ocular mobility and visual acuity and painless subcutaneous nodules on the right hemiface. Nasoendoscopy showed no changes in the left or nasopharynx; in the right, edema and mucosa hyperemia obstructing the upper airway and purulent rhinorrhea. Contrast computerized tomography (CT) of sinuses and orbit revealed extraconal infiltrating and expanding injury compromising orbit and right periorbit, with eyeball proptosis; maxillary, sphenoid sinus, ethmoidal cells, frontal sinus, and nasolacrimal duct were obliterated; and infiltration of the skin and subcutaneous on the right was identified (Figure 1B and C). Abdomen CT revealed splenomegaly (15.5 cm). Pelvis and chest CT were normal. Serologies, rheumatic tests, hemoculture, uroculture, and Mantoux were negative. During admission, cefepime was commenced for febrile neutropenia. Biopsy of the lesion via nasal endoscopy in the right nasal cavity was performed with Epstein-Barr virus (EBV) checking positive. There was not enough material for diagnosis through immunohistochemistry due to the large amount of necrotic material. There was a gradual worsening of pancytopenia, increase in lactate dehydronagenase (LDH), and episode of right severe epistaxis, which was controlled with nasal packing. Bone marrow biopsy was carried out due to the suspicion of lymphoma, with negative result. Prednisone was initiated in lower doses, and new biopsy of the lesion in the right nasal cavity was performed through lateral rhinotomy, anatomopathology examination identified lymphoma. Extranodal natural killer /T-cell lymphoma, nasal type (ENKL) was confirmed by immunohistochemistry. Treatment with radiotherapy and outpatient chemotherapy was commenced.
Rev Bras Reumatol, Aug 1, 2002