Unusual Initial Presentation of Primary Antiphospholipid Syndrome as Postpartum Symmetrical Peripheral Gangrene

Khan, Marium Marufia; Shahid, Sana; Zafar, Amara; Khan, Nudrat Naz; Bhatty, Shaheen

doi:10.55519/jamc-01-8695

Cited by 4 publications

(5 citation statements)

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“…A French study of Mansour et al ( 25 ) reported of 14 recurrences following NA and 4% recurrence rate following ID in their study cohort. Khan et al ( 26 ) reported of 60 patients with a successful PTA drainage. Nevertheless, all recommendations are based on retrospective study data and small study cohorts ( 23 , 27 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

The peritonsillar abscess and its management – is incision and drainage only a makeshift to the tonsillectomy or a permanent solution?

Ketterer,

Maier,

Burkhardt

et al. 2023

Front. Med.

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IntroductionThis study aims to examine the long-term management of peritonsillar abscess and compare needle aspiration, incision with drainage, and tonsillectomy in terms of comorbidities, complication rates, and recurrences in the largest study cohort published to date.MethodsWe conducted a retrospective analysis of patients, both adults and children, who were treated for peritonsillar abscess between 2007 and 2019. Patient charts were analyzed to assess surgical treatment, infection and inflammation rates, risk of bleeding, recurrence rates, duration of illness, and sick certificates. Additionally, patient imaging and blood levels were compared. Postal questionnaires were sent to all patients to evaluate subjective success rates, complications, and long-term benefits of the different treatment regimens. General practitioners and ENT doctors in private practices were contacted to gather missing data on the long-term course of the disease.ResultsA total of 821 patients with peritonsillar abscess were included in this study. Two patients had to be excluded due to incidental pathological findings. Of the remaining 819 patients, 180 were successfully treated with needle aspiration or incision. Among these patients, 37.7% required tonsillectomy during the same inpatient stay. Laboratory parameters such as leukocyte count or C-reactive protein levels were not indicative of the need for tonsillectomy. Furthermore, computed tomography was only necessary in cases of suspected parapharyngeal abscess, not in clear cases of peritonsillar abscess. Among the 641 patients who underwent tonsillectomy, 11.4% experienced postoperative bleeding requiring treatment. Only patients who underwent bilateral tonsillectomy reported recurrent episodes of sore throat and pharyngitis resulting in absence from work. The ipsilateral recurrence rate for peritonsillar abscess after needle aspiration or incision was 2.8%. There were no contralateral recurrences during the observation period.ConclusionDue to the lower risk of postoperative bleeding, shorter absence from work, and shorter inpatient stay, incision and drainage are the preferable treatment for peritonsillar abscess. Additionally, patients who underwent bilateral tonsillectomy reported higher rates of work incapacity due to sore throat caused by pharyngitis. No patient met the clear indication for bilateral tonsillectomy due to recurrent acute tonsillitis. The recurrence rate after drainage without tonsillectomy was very low (2.8% ipsilaterally, no recurrence contralaterally).

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Section: Discussionmentioning

confidence: 99%

The peritonsillar abscess and its management – is incision and drainage only a makeshift to the tonsillectomy or a permanent solution?

Ketterer,

Maier,

Burkhardt

et al. 2023

Front. Med.

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“…as symmetrical peripheral gangrene. 3,4 Symmetrical peripheral gangrene can be an initial presentation of APS syndrome 5 or can present in the later course of the disease. 3 APS syndrome should be suspected and investigated in young patients presenting with symmetrical peripheral gangrene.…”

Section: Antiphospholipid Antibody (Aps) Syndrome Can Rarely Presentmentioning

confidence: 99%

Symmetrical peripheral gangrene: a rare and early presentation of antiphospholipid syndrome

Lal,

Danish,

Tyagi

et al. 2024

Int J Dermatology

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Symmetrical peripheral gangrene: a rare and early presentation of antiphospholipid syndrome Symmetrical peripheral gangrene is characterized by the simultaneous development of gangrene in two or more extremities. It may arise because of various conditions, such as peripheral vascular disease (likely the most common cause of symmetrical peripheral gangrene), sepsis, infections, conditions involving decreased cardiac output, hypercoagulable states, vasospastic disorders, hyperviscosity syndromes, insect or animal bites, and others. Early recognition and treatment are necessary to prevent serious consequences. We report a case of symmetrical

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“…Die bevorzugte chirurgische Behandlung hängt von den Patienten, der Compliance und der Erfahrung des konsultierten Arztes ab. Auch in der Literatur zeigten mehrere Studien gute Wirksamkeitsraten mittels Spaltung im Vergleich zur Tonsillektomie [ 11 , 14 , 25 ].…”

Section: Diskussionunclassified

“…Die Peritonsillitis bezeichnet die Ausbreitung auf das Peritonsillargewebe ohne Eiterverhalt [ 3 , 16 ]. Typische Symptome des PTA sind Odyno‑/Dysphagie, kloßige Sprache, Kieferklemme und beginnende Dyspnoe [ 14 , 31 ]. Zumeist zeigt sich eine unilateral geschwollene Tonsille, eine Rötung und Schwellung des Weichgaumens, Asymmetrie des Oropharynx sowie ein Uvulaödem begleitet von Fieber und Abgeschlagenheit [ 3 , 16 ].…”

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Disproving the myth of “abscess weather” predisposing to peritonsillitis and peritonsillar abscess

von Meyer,

Storck

2023

HNO

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Zusammenfassung Hintergrund Der Peritonsillarabszess (PTA) wird häufig als Komplikation der akuten Tonsillitis gesehen und ist definiert als Eiterverhalt zwischen der Tonsillenkapsel und dem peritonsillären Gewebe. Die Ätiologie und Pathogenese sind bisher noch nicht vollständig geklärt. Ein Zusammenhang zwischen bestimmten Wetterbedingungen und Temperaturschwankungen und dem Auftreten von Abszessen im Kopf-Hals-Bereich wird seit Jahren diskutiert. Hierbei ist die Frage, ob höhergradige Temperaturschwankungen prädisponierend sind für die Ausbildung von Abszessen. Material und Methodik Es erfolgte eine retrospektive Auswertung aller Patienten, die in einem Zeitraum von 10 Jahren (2012–2021) in der Klinik und Poliklinik für Hals, Nasen‑, Ohrenheilkunde des Klinikums rechts der Isar der Technischen Universität München mit einer Peritonsillitis oder einem PTA stationär behandelt wurden. Jeder Patient wurde einzeln mit den täglichen Temperaturdaten des statistischen Wetteramts für die Stadt München korreliert. Ergebnisse Insgesamt konnten 1450 Patienten in die Studie eingeschlossen werden. Von den 1450 Patienten hatten 270 Patienten (18,62 %) eine Peritonsillitis, 1180 Patienten (81,38 %) einen PTA. Eine Korrelation zwischen dem Auftreten von Peritonsillitiden oder PTA und größeren Temperaturschwankungen konnte in diesem großen Patientenkollektiv ausgeschlossen werden. Auch zeigte sich über das ganze Jahr eine ähnliche Häufigkeit von Peritonsillitiden und PTA. Schlussfolgerung Peritonsillitiden oder Peritonsillarabszesse entwickeln sich nach Datenlage der vorliegenden Studie wetterunabhängig.

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Unusual Initial Presentation of Primary Antiphospholipid Syndrome as Postpartum Symmetrical Peripheral Gangrene

Cited by 4 publications

References 0 publications

The peritonsillar abscess and its management – is incision and drainage only a makeshift to the tonsillectomy or a permanent solution?

The peritonsillar abscess and its management – is incision and drainage only a makeshift to the tonsillectomy or a permanent solution?

Symmetrical peripheral gangrene: a rare and early presentation of antiphospholipid syndrome

Disproving the myth of “abscess weather” predisposing to peritonsillitis and peritonsillar abscess

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