Massive Enlargement of The Tongue

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Case Report

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Case Report

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Farzad Ferdosian¹ , Zahra Mohsenolhoseini^2* , Razieh Fallah¹

Coronaviruses (CoVs) are single-stranded RNA viruses described for >50 years. Novel coronavirus (SARS-Coronavirus-2: SARS-CoV-2) emerged in Wuhan and has spread globally.

Coronavirus Disease 2019 (COVID-19) symptoms are primarily pulmonary (fever, dry cough, fatigue, pneumonia); however, other organs can be affected, including the gastrointestinal tract, kidneys, liver, heart, and brain.

Pediatric COVID-19 is milder than the adult’s type. Children with severe disease often have an underlying co-morbidity, such as chronic lung disease or immunosuppression.

SARS-CoV-1, MERS-CoV, HCoV-OC43, and HCoV-229E are associated with neurological complications. Neurological manifestations of COVID-19 are not well understood in adults or children, and these manifestations are not rare. The number of patients with neurological manifestations has been increasing Recently, especially in the third peak of the disease.

Early diagnosis and timely management may lead to a better outcome. There are limited reports of neurological complications in the pediatric population. Further studies are required for early diagnosis and better results. We reported the third case of encephalitis in children without any respiratory or gastrointestinal manifestation.

A 7-year-old male was admitted with fever and loss of consciousness. He presented no respiratory or gastrointestinal symptoms. He reported no medical history and history of substance abuse. Laboratory findings confirm that neurological manifestations might be expected in covid-19 infections, despite the absence of respiratory symptoms. The patient was treated, and the level of consciousness was gradually improving. Supportive treatment and outpatient follow-up were recommended.

A B S T R A C T

Running Title Encephalitis Associated with COVID-19

Article info:

Received: 16 Nov 2021 Revised: 24 Nov 2021 Accepted: 25 Dec 2021

Keywords:

Case Report

* Corresponding Author:

Zahra Mohsenolhoseini, MD.

Address: Shahid Sadoughi Hospital, Ave-Sina Blvd, Shahid Ghandi Blvd, Yazd, Iran.

E-mail: [email protected] Coronavirus disease 2019;

COVID-19; Child; Encephalitis November/December 2021, Volume 6, Issue 6

Citation Ferdosian F, Mohsenolhoseini Z, Fallah R. Encephalitis Associated with COVID-19 in a 7-Year-Old Boy: A Case Report. Case Reports in Clinical Practice. 2021; 6(6):246-250.

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1. Department of Pediatrics, Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

2. Department of Pediatrics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

A B S T R A C T

Article info:

Keywords:

Case Report

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1. Department of Pediatrics, Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

2. Department of Pediatrics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

A B S T R A C T

Article info:

Keywords:

Case Report

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A B S T R A C T

Article info:

Keywords:

Case Report

A B S T R A C T

A 35- year- old woman presented with massive enlargement of the tongue. She had suffered this problem since a week ago when her tongue became enlarged with a sudden onset and eventually did not fit her mouth. Chronic tongue enlargement since childhood is noted. Patient had history of mental problems, namely cerebral palsy, and as she is not able to walk, she uses a wheelchair. Furthermore, due to severe scoliosis, right lung was atelectatic.

Soon after initial assessments, she was carried to surgery room and as she could not lie down to supine position, was intubated in sitting position with a rigid laryngoscope.

During the whole process, patient was sedated. Afterwards, tracheostomy was performed.

After 5 days, no improvement in the size of tongue was observed. Diagnosis was revised in a medical commission and despite inflammatory pathology, the bulging tongue was resected.

After recovery, patient could bear oral feeding and was dismissed with good general health. After a week, the devised airway created by tracheostomy was removed without any complication. During one-year follow up, no sequelae were observed.

Article info:

Received: 06 April 2022 Revised: 24 April 2022 Accepted: 11 May 2022

Keywords:

Massive enlargement of the tongue, Glossitis, Lingual hypertrophy

Saeed Sohrabpour, MD-MPH

Address: Otorhinolaryngology Research Center, Amir Alam Hospital, North Sadi Ave, Tehran, Iran. Postal Code: 1145765111 E-mail: [email protected]

Case report

A 35- year- old woman presented with massive enlargement of the tongue. She had suffered this problem since a week ago when her tongue became enlarged with a sudden onset and eventually did not fit her mouth. Chronic tongue enlargement since childhood is noted. Patient had history of

mental problems, namely cerebral palsy, and as she is not able to walk, she uses a wheelchair. Furthermore, due to severe scoliosis, right lung was atelectatic. Her father had no history of seizures.

Vital signs were normal and she had no dyspnea. On examination, an ulcer was observed on the dorsum of the tongue and no submucosal tumor could be palpated (Fig. 1).

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Case Report

Journal Homepage: http://crcp.tums.ac.ir

Case Report

Journal Homepage: http://crcp.tums.ac.ir

Case Report

Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Massive Enlargement of t he Tongue: A Report of Unusual Case

Erfanian R, Heidari F, Sohrabpour S, Shakiba S. Massive Enlargement of the Tongue: A Report of Unusual Case. Case Reports in Clinical Practice. 2022; 7(2): 79-81.

Reza Erfanian , Farrokh Heidari , Saeed Sohrabpour* , Saeed Shakiba

March/April 2022, Volume 7, Issue 2

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Soon after initial assessments, she was carried to surgery room and as she could not lie down to supine position, was intubated in sitting position with a rigid laryngoscope. During the whole process patient was sedated. Afterwards, tracheostomy was performed.

Further histopathological evaluations carried out by several biopsies of tongue and subcutaneous abdominal fat revealed chronic infection and no acute infection of the tongue. Moreover, samples did not stain with Congo red.

Primary diagnosis was tongue abscess and subsequent inflammation; thus the treatment with ceftriaxone, clindamycin and dexamethasone was initiated. Several sterile gauzes along with pharyngeal pack were placed between the rows of teeth in order to prevent the entry of blood, secretions and antiseptic solution into the stomach and trachea.

After 5 days, no improvement in the size of tongue was observed. Diagnosis was revised in a medical commission and despite inflammatory pathology, the bulging tongue was resected.

After recovery, patient could bear oral feeding and was dismissed with good general health. After a week, the devised airway created by tracheostomy was removed without any complication. During one-year

follow up, no sequelae were observed.

Discussion

Tongue swelling is relatively uncommon condition that can be either congenital or acquired. Variety of conditions such as lymphatic vascular malformations, Beckwith-Wiedemann syndrome, hemangioma, Down syndrome and hypothyroidism may cause congenital macroglossia.[1]

Acquired macroglossia might occur gradually or acutely. Gradual acquired macroglossia might be because of tumor infiltration, amyloidosis or myxedema. Acute enlargement of the tongue is rare but most of the times it can be life-threatening.

According to Renehan and Morton acute swelling of the tongue could be divided into 4 categories:

infection(tongue abscess), hemorrhage, edema, and infarction.[2]

Swelling of the tongue can be restricted to a specific region; the so-called local swelling which is asymmetric most of the times, or might be the generalized swelling involving most of the tongue.

Kawaguchi et al. reported a case in which the main cause of the tongue swelling had been mechanical obstruction of venous and lymphatic return by pharyngeal packs during neurosurgical procedure. [3]

Fig. 1. The head and neck CT-scan illustrates extensively large tongue protruding from the patients mouth.

Erfanian R, et al. Enlargement of the Tongue. CRCP. 2022; 7(2):79-81

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The first line management and treatment of acute

or chronic would be conservative and supportive. A suggested conservative treatment for macroglossia due to chronic trauma to the tongue would be modified bite guard.[4] When the patient is unresponsive to the first line then invasive surgical incision, namely partial glossectomy, becomes treatment of choice.

Recurrence of tongue swelling and mental problems could be the possible culpable by which the tongue had been ulcerated and as a result, microorganism had been introduced into tongue tissue causing chronic inflammation. In our case, tongue abscess was rolled out because the patient was unresponsive to antibiotics. Moreover, movement and mental disorder might be responsible for lack of adequate oral care and mechanical injuries to the tongue. The important feature of our case was the outstanding remission after tongue incision, though the course of disease had indicated infection and inflammation.

Ethical Considerations

Informed consent was obtained from the patient and the patient›s information was used anonymously and in compliance with ethical principles.

Compliance with ethical guidelines

There were no ethical considerations to be considered in this research.

Funding

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors^, contributions

All authors equally contributed in preparing this article.

Conflict of interest

Authors declare that there is no conflict of interest.

References

[1] Gadban, H., et al., Acute edema of the tongue: a life- threatening condition. 2003. 112(7): p. 651-653. https://doi.

org/10.1177/000348940311200714

[2] Renehan, A., M.J.B.J.o.O. Morton, and M. Surgery, Acute enlargement of the tongue. 1993. 31(5): p. 321-324. https://doi.

org/10.1016/0266-4356(93)90071-4

[3] Kawaguchi, M., et al., Pharyngeal packs can cause massive swelling of the tongue after neurosurgical procedures. 1995.

83(2): p. 434-435.

https://doi.org/10.1097/00000542-199508000-00037 [4] Karayazgan-Saracoglu, B. and D.J.J.o.C.S. Kecik, Utilization of

a modified bite guard for preventing traumatic macroglossia.

2011. 22(1): p. 238-240.

https://doi.org/10.1097/SCS.0b013e3181f7b6b5

Erfanian R, et al. Enlargement of the Tongue. CRCP. 2022; 7(2):79-81