Eosinophilic granuloma in the head and neck: a five year review with report of an instructive case.

Head and neck symptoms occurred in 87% of patients (14 of 16) with eosinophilic granuloma seen in a 5 year period. Two patients with head and neck disease died (14% mortality). Both had concomitant pituitary disease. The underlying pathology was discovered in each instance only after a year of extensive diagnostic effort. The specific problems in diagnosis and treatment are apparent in the case report of an initially misdiagnosed patient. The following recommendations are suggested to optimize the care of such patients. Eosinophilic granuloma must be suspected in a variety of clinical settings. Radiography is the only helpful noninvasive study and definitive diagnosis depends on microscopic tissue examination. Patients with symptoms of pituitary disease pose a frustrating diagnostic problem because of the inaccessibility of the location for pathologic study. In contrast, the head and neck, ear, nose and throat are easily biopsied and comprise the region most frequently involved. A careful examination of this area is mandatory in all patients with symptoms consistent with eosinophilic granuloma intracranially or elsewhere if the disease is to be diagnosed and treated without delay.