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e-mail: endos@dialup.ptt.ru
Dear colleagues,

We ask you a favour to take part in discussion on the following patient to verify the diagnosis and to elaborate the rational therapeutic strategy. The patient is a female of 26, the diagnosis is "Melkersson-Rosenthal syndrome", the treatment is ineffective. The patient herself believes that her disease is connected with tonsillectomy. We would like to have your expert opinion on the following questions:
1. What shall we do to verify the diagnosis?
2. What kind of therapy could you recommend?

Anamnesis vitae:

childhood:
acute pharyngitis
chronic granulomatous pharyngitis
submandibular lymphadenitis
intestinal lambliosis
sinusitis maxillaris
chronic periodontitis
During 7-14 years of life
Right-side pneumonia, chronic adenoiditis, chronic granulomatous pharyngitis, billiary dyskenesia.
In April 1987 the patient had the diagnosis of chronic hypertrophic tonsillitis with enlarged lymphonodes. Tonsillectomy was recommended. From that date till 1995 the patient had regular exarcerbations of her tonsillitis. She received antibiotics.

Anamnesis morbi:

In August 1995 there appeared the spot on her face, beneath the right eye, near the nose. The spot appeared during the holydays spent in the subtropical region. Simultaneously she had adnexitis, treated by a gynecologist.
Examination: on the right cheek, near the nose there is the focus of irregular form with sharp margins, presented as a erythematous spot with infiltrated basis. Diagnosis: Lupus erythematosus discoides?

In October 1995 there appeared the fresh infiltrated spot.

In February 1996 the patient underwent tonsillectomy on both sides. Postoperative period without any complications. All the laboratory data at discharge were normal.

In April 1996 there were revealed yeastlike fungi in the feaces.
In August 1996 - acute cystitis.

25 November 1996 the patient again had the spot beneath her right eye. She was consulted by an oculist, who found no ophtalmic pathology. The dermatologist diagnosed lupus erythematosus discoides.
Up to the January of 1997 her condition did not chage for the better. Another consultant dermatologist diagnosed Melkersson-Rosenthal syndrome. The patient received 30 mg of prednisolone daily and potassum preparations. The patient used no local medications.

Now the course of the disease has the tendency for the worse. There is the purulent discharge from the affected skin with unpleasant smell.
Otorhinolaryngology organs are in normal status.

Immune status:
Leucocytes 4.7 x 103 mm3
Lymphocytes 52% or 2.4 x 103 mm3
lymphocytes subpopulations:
mature T-lymphocytes 69 % or 1.7 x 103 mm3
T-helpers 44 % or 1.1 x 103 mm3
T-suppressors 27 % or 0.6 x 103 mm3
Regulatory index 1.6
NK-cells 19 % or 0.45 x 103 mm3
HLA-DR+ cells 8 %
Serum immunogobulines:
IgG 14.0 g/l
IgA 4.3 g/l
IgM 1.8 g/l
C-reactive protein 0.
Phagocytosis 20%
The number of active phagocytes 0.4 x 109/l
The absolute phagocyte index 21.0 x 109/l
Immunologist's opinion: there is marked decrease of percent and absolute number of phagocytes.
Other parameters are normal.

Emotional status of the patient is markedly depressed by her cosmetic defect.
The patient's image is presented.

Thus, thank you beforehand for your opinions.

You can connect with us by our e-mail: endos@dialup.ptt.ru