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Aleksandar Perić, Danilo Vojvodić, Biserka Vukomanović-Đurđević and Nenad Baletić

Eosinophilic Inflammation in Allergic Rhinitis and Nasal Polyposis

On histopathological examination, nasal polyps and nasal mucosa in allergic rhinitis show different forms of pseudostratified respiratory epithelium, whereas the dominant characteristic of lamina propria is an eosinophilic infiltration. The aim of this study was to compare interleukin (IL)-5 and eosinophilic cationic protein (ECP) levels in the nasal fluid of 42 patients: 12 with allergic rhinitis and nasal septal deviation, 17 non-atopic patients with nasal polyposis, and 13 atopic nasal polyp patients were enrolled in this cross-sectional study. Nasal secretion samples were collected a few days before surgery. The levels of IL-5 were measured using flow cytometry and the ECP using a commercial ELISA kit. In addition, we counted eosinophils in hematoxylin-and-eosin-stained sections of all nasal polyp and all nasal mucosa samples taken from the inferior nasal turbinates during septoplasty. A significantly higher concentration of IL-5 was found in the nasal fluid of atopic patients with nasal polyposis than in non-atopic nasal polyp patients (p=0.025) and patients with allergic rhinitis (p=0.05). ECP was higher in atopic nasal polyp patients than in patients with allergic rhinitis (p<0.0001) and than in non-atopic nasal polyp patients (p<0.0001). Polyp eosinophils were higher in atopic' than in non-atopic patients (p<0.0001) and higher than in the mucosa of patients with allergic rhinitis (p<0.0001). These however had significantly more mucosal eosinophils than was found in the polyps of non-atopic patients' (p=0.025). ECP levels in nasal fluid and eosinophil counts in tissue specimens correlated well in all three groups of patients. Our study has shown that atopic nasal polyp patients have a higher level of eosinophilic inflammation than non-atopic patients with nasal polyps and patients with allergic rhinitis.

Open access

Aleksandar Perić, Milan Erdoglija, Nenad Mladenović and Biserka Vukomanović Đurđević


The paranasal sinus mucocele is an epithelized cystic lesion containing fluid and is characterized by non-neoplastic expansion of the paranasal sinus due to its capacity to erode the overlying bone. Etiology of these lesions is still under debate. In this report, we described a case of a patient with frontal recess mucocele, associated with contralateral frontal recess osteoma. A 55-year-old man was admitted to the Department of Otorhinolaryngology of our hospital with the complaints of a headache affecting the fronto-ethmoidal region, left-sided nasal obstruction, and postnasal discharge. Computed tomography (CT) scan of the paranasal sinuses showed a dense bony lesion in the left and a cystic hypodense mass in the right-sided frontal recess. The patient was treated surgically, with a combined endoscopicexternal approach, bilaterally. Histopathological examination showed that the wall of the cyst was mucocele, and the bony formation was osteoma. The frontal recess osteoma is regarded as the primary condition. Thus, better ventilation and drainage of the frontal sinus were reestablished.

Open access

Tijana Boljević, Željko Mijušković, Lidija Kandolf Sekulović and Biserka Vukomanović-Đurđević


Swimming-pool granuloma and fish tank granuloma refer to the infections caused by Mycobacterium marinum. After having been discovered in salt water fish in Philadelphia Aquarium and described in 1926, this skin infection was first reported in humans in 1951. It developed in people who had swum in contaminated swimming pools. M. marinum is a non-tuberculous, atypical mycobacterium, which is found on plants, soil and fish in freshwater and salt water worldwide. Humans become infected usually after trauma and contact with an aquatic environment. Infection is limited to the skin and usually occurs in healthy individuals, but in immunocompromised patients the infection may disseminate or spread to the subcutis and bone. The lesions usually appear as solitary nodules or plaques that may lead to suppurative ulcers after 2-3 weeks of incubation. Occasionally, there may be sporotrichoid spread along lymphatics. Its diagnosis is frequently delayed, probably because the infection is very rare and a history of aquatic exposure, which is present in the majority of cases, is often overlooked. Common misdiagnoses include fungal and parasitic infection, cellulitis, verrucous tuberculosis of the skin, gout, rheumatoid arthritis, a foreign body and a skin tumour. We present a case of a 39-year-old Caucasian male with a 12-month history of a single erythematous tender nodule on the right dorsal aspect of the right hand. Histopathological examination revealed longstanding suppurated granulomatous inflammation. The infection was not responsive to several courses of antibiotics until we introduced doxycycline capsules as monotherapy which led to complete remission after 5 months.