Proliferative Fasciitis/Myositis Involving the Facial Muscles Including the Masseter Muscle: A Rare Cause of Trismus

Abstract

Patient: Male, 50Final Diagnosis: Proliferative fasciitis/myositisSymptoms: Facial swelling • fever • trismusMedication: —Clinical Procedure: BiopsySpecialty: PathologyObjective:Rare diseaseBackground:Proliferative fasciitis/myositis is a benign disease that can be treated conservatively. However, some patients are mistakenly treated surgically because of a misdiagnosis of the condition as a malignant tumor.Case Report:A 50-year-old Japanese man developed swelling in his left cheek 12 days before admission; he developed a fever and trismus 3 days later. He was admitted to our hospital because of worsening of his condition despite treatment with sitafloxacin for 5 days and needle-aspiration drainage. On admission, he had a fever of 38.1°C, swelling in his left cheek spreading to the lower jaw, and several dental caries. Although ceftriaxone and clindamycin were administered for 7 days because an odontogenic infection was suspected, his condition did not improve. T2-weighted magnetic resonance imaging of the facial muscles on Day 5 of hospitalization showed swelling and high-intensity signals in the left masseter, temporalis, and pterygoid muscles. Macroscopic findings from a biopsy of the left temporalis muscle performed on Day 17 showed white and thickened fascia. Histopathological examination revealed fibrous hyperplasia of the fascia, increased fibrous connective tissue between muscle fibers, and infiltration of inflammatory cells, providing not a definite but a compatible diagnosis of proliferative fasciitis/myositis. Beginning on Day 18, the patient’s fever lessened with gradual improvement of his facial swelling and trismus.Conclusions:It is imperative to include proliferative fasciitis/myositis as a possible diagnosis when patients present with facial swelling and trismus of unknown cause.

<p>Status Quo of Diagnostic Procedures and Treatment of Inpatients with Infective Endocarditis at the Department of General Medicine at a University Hospital in a Suburban City in Japan: A Single-Hospital-Based Retrospective Study</p>

“…The general medicine department of this hospital manages the first-touch practice of outpatients without a reference from their primary doctors, in addition to treating both in-and outpatients with common diseases, fevers of unknown origin, diseases that are difficult to correctly diagnose, and complicated pathological situations requiring intensive care. [4][5][6][7] In this study, patients suspected of having, or diagnosed with IE before admission would, in principle, be seen by the endocarditis team of the department of cardiology and cardiovascular surgery. In comparison, patients with non-specific symptoms and signs such as fever of unknown origin, consciousness disorder, paralysis, or rash, who were not suspected of having, or were not diagnosed with IE prior to referral, would initially be seen by the department of general medicine, emergency medicine, neurology, or dermatology or whatever department seemed appropriate.…”

“…3 Among these departments, the general medicine departments, especially at university hospitals in Japan, which are often in charge of diagnosing diagnostically challenging diseases, including fevers of unknown origin, are likely to see patients with IE. [4][5][6][7] Our previous research showed that the general medicine department of Saga University Hospital in Japan diagnosed and treated the third-highest number of inpatients with IE after the departments of cardiology and cardiovascular surgery. 4 The department of cardiovascular surgery plays a clearly delineated role in treating IE in terms of when and how to operate and how to manage patients after surgery.…”