Skip to main content

Advertisement

SpringerLink
Log in

Head and neck lesions in the immunocompromised host

  • Head and Neck
  • Published:
European Radiology Supplements

Abstract

Head and neck lesions are encountered in more than 40–50% in patients with immunosuppression (HIV-infected individuals, diabetes mellitus, transplant recipients, patients treated with immunosuppressive drugs or post-radiotherapy). The organs affected are the salivary glands, the lymph nodes, the sinonasal tract, the orbits, the temporal bones, and the pharyngo-laryngeal mucosa. They are mainly involved by granulation tissue, perivascular and perineural inflammation, and neoplasms. In the pediatric population the temporal bone is the most frequent target organ. The most common clinical manifestation of salivary gland involvement is non-specific bilateral painless enlargement of the parotid gland and xerostomia. Lymphoepithelial cyst, sialosis, and lymphoma may be present. The high rate of salivary gland involvement is probably related to the presence of the human immunodeficiency virus within the saliva. Surgery, sclerotherapy by doxycycline, or low-dose radiotherapy may prevent further growth of tumoral lesions. Sinonasal diseases are the most frequent lesions which manifest in immunosuppressed adult patients (66%). They are associated with a trend of decreased survival rate. Invasive aspergillosis is defined by hyphae in the submucosa, and tumor necrosis without host inflammatory response; it may be lethal in 50–80%, especially when the skull base is involved. Computed tomography shows erosion of bone and extrasinonasal extension. The hypointensity of the lesion on T2-weighted images may suggest the diagnosis. Fungal sinus disease can affect 1–10% of transplant recipients and should be suspected when organ rejection is considered. The temporal bone is the most frequent target organ in the immunosuppressed pediatric population due to Eustachian tube dysfunction. Otomastoïditis, necrotizing external otitis, and otosyphilis are reported. Prompt treatment may avoid lateral sinus thrombosis. Epithelial neoplasms, lymphomas, and Kaposi’s sarcoma may also be considered. Kaposi’s sarcoma, the most common neoplasm encountered in patients with AIDS, is an indicator of the progression of human immunodeficiency virus infection to AIDS. The lesions are often multifocal at presentation and may affect the skin, the mucosa, and visceral organs. The pathogenesis is unclear, but cytokines and growth factors may play a role. In conclusion, immunosuppressed patients are likely to develop virulent infection with vascular complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1a–c.
Fig. 2a, b.
Fig. 3.
Fig. 4.
Fig. 5a–c.
Fig. 6.
Fig. 7a, b.
Fig. 8a, b.
Fig. 9a–c.
Fig. 10a–c.
Fig. 11a–c.
Fig. 12.
Fig. 13.
Fig. 14a–e.
Fig. 15.
Fig. 16a–d.
Fig. 17.
Fig. 18a, b.
Fig. 19a–c.

Similar content being viewed by others

References

  1. Tami TA, Ferlito A, Rinaldo A, Lee KC, Singh B (1999) Laryngeal pathology in the acquired immunodeficiency syndrome diagnostic and therapeutic dilemmas. Ann Otol Rhinol Laryngol 108:214–220

    Google Scholar 

  2. Truitt TO, Tami TA (1999) Otolaryngologic manifestations of human immunodeficiency infection. Med Clin North Am 83:303–315

    Google Scholar 

  3. Marsot-Dupuch K, Meyohas MC, Schmitt E, Prudhom de Saint Maur P, Woimant H (2000) Pathologie de la sphère ORL au cours du syndrome d’immunodéficience acquise: apport de l’imagerie. Encycl Méd Chir Radiodiagnostic-Neuroradiologie 31–675 D-10, 13 pages

  4. Schrot RJ, Ademan HM, Linden CN, Wallach PM (1997) Cystic parotid gland enlargement in HIV disease. the diffuse infiltrative lymphocytosis syndrome. J Am Med Assoc 278:166–167

    Article  CAS  Google Scholar 

  5. Barnes L, Myers EN, Prokopakis EP (1998) Primary malignant lymphoma of the parotid gland. Arch Otolaryngol Head Neck Surg 124:573–577

    Google Scholar 

  6. Chong WK, Hall-Craggs MA, Wilkinson ID et al. (1993) The prevalence of para-nasal sinus disease in HIV infection and AIDS on cranial MR imaging. Radiology 47:166–169

    CAS  Google Scholar 

  7. Goulon AR, Loevner LA, Sonners AI, Bolger WE, Wasile MA (2002) Post-transplantation lymphoproliferative disorder of the paranasal sinuses mimicking invasive fungal sinusitis. AJNR 23:855–857

    Google Scholar 

  8. Rumbolt Z, Castillo M (2002) Indolent intracranial mucormycosis. AJNR 23:932–934

    Google Scholar 

  9. Chandrasekhar SS, Siverls V, Chandra-Sekhar HK (1992) Histopathologic and ultrastructural changes in the temporal bones of HIV-infected human adults. Am J Otol 13:207

    CAS  PubMed  Google Scholar 

  10. Ress BD, Luntz M, Telishi FF, Balkany TJ, Whiteman MLH (1997) Necrotizing external otitis in patients with AIDS. Laryngoscope 107:456–460

    Google Scholar 

  11. Singh B, Har-el G, Lucente FE (1994) Kaposi’s sarcoma of the head and neck in patients with acquired immunodeficiency syndrome. Otolaryngol Head Neck Surg 111:618–624

    CAS  PubMed  Google Scholar 

  12. Kempf VAJ, Volkmann B, Schaller M et al. (2001) Evidence of a leading role for VEGF in Bartonella henselae-induced endothelial cell proliferations. Cell Microbiol 3:263

    Google Scholar 

  13. Hnatuk LA, Brown DH, Snell GE (1994) Bacillary angiomatosis: a new entity is acquired immunodeficiency syndrome. J Otolaryngol 23:216–220

    CAS  PubMed  Google Scholar 

  14. Loevner LA, Karpati RL, Kumar P, Yousem DM, Hsu W, Montone KT (2000) Post-transplantation lymphoproliferative disorder of the head neck: imaging features in seven adults. Radiology 216:363–369

    CAS  PubMed  Google Scholar 

  15. Gordon AR, Loevner LA, Sonners AI, Bolger WE, Wasik MA (2002) Post-transplantation lymphoproliferative disorder of the paranasal sinuses mimicking invasive fungal sinusitis: case report. AJNR 23:855–857

    Google Scholar 

  16. Haller JO (1997) AIDS-related malignancies in pediatrics. Pediatr Oncol Imaging 35:1517–1538

    CAS  Google Scholar 

Download references

Acknowledgement

The authors thank J. Mahadevan for her valuable advice on preparation of this article.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, University Hospital of Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France

    K. Marsot-Dupuch

  2. Department of Pathology, University Hospital of Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France

    J. Quillard

  3. Department of Infectious Diseases, University Hospital of Saint Antoine, 184 Rue du Fbg Saint Antoine, 75012, Paris, France

    M. C. Meyohas

Authors
  1. K. Marsot-Dupuch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Quillard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. C. Meyohas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Marsot-Dupuch.

Additional information

ECR 2004 - Categorical Course “Infection in the adult today”

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marsot-Dupuch, K., Quillard, J. & Meyohas, M.C. Head and neck lesions in the immunocompromised host. Eur Radiol Suppl 14, E155–E167 (2004). https://doi.org/10.1007/s00330-003-2045-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-003-2045-y

Keywords

Search

Navigation