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Foreign bodies
I remember that at the age of about 3, my brother developed a horrific smell that
enveloped his entire body. It turned out that the smell came from his having stuffed paper
tissue up his nose...
A common pastime of little children is sticking things up their nose. Luckily, most common
household items don't fit into the nostrils of a small child, but then again, some do -
pieces of paper, peas, beans, seeds, pencil erasers are just some examples. If the
material stuck up the nose absorbs water, it quickly becomes full of bacteria and their
stinky metabolic products. Any child presenting with an offensive smell should have his
nostrils examined immediately. Unfortunately, many doctors are not aware of this. This is
complicated by the fact that with time, the smell appears to be coming from the entire
body. This led some doctors to report (erroneously, I think) that the smelly molecules
were originating in the nose, but subsequently got into the bloodstream and coming out of
pores in the skin.
If the "foreign body" up the nose does not absorb water, it may not smell for
many months. With time, the foreign body may become coated with calcified material. It may
impede the proper flow of air through the nostrils, cause a low grade infection, and lead
to an odor which may not be overwhelming.
In 1991 we had an interesting case of a 28 year old who complained of bad breath. She had
three different kinds of odor. One was a slight oral odor. The second was cigarette odor.
The third was a slight, but 
noticeable,
peculiar odor from the nose itself. This prompted me to send her to an outstanding
ear-nose-throat specialist, the department head in a major hospital outside of Tel Aviv
area. He found the presence of a "foreign body" up her nose (When I asked him
later, "how come you found it when other ENT specialists didn't", his laconic
reply was "I looked for it"). The foreign body was covered with calcified
material, and had to be removed under anesthesia at the hospital. The foreign body turned
out to be a child's bead, probably left up her nose some twenty-five years earlier.
Probably, because it was plastic, it didn't smell for years. Interestingly, although the
smell was slight, she complained of fierce odor, and was very upset that others,
especially doctors, had trouble noticing it. Perhaps, since it was lodged in her nose, the
concentration that she smelled was much higher than was smelled by others when she
exhaled.
Following this story, I went back to read a few articles on odor resulting from nasal
foreign bodies. Thus, when I received a call from a mother in November, 1992, I had a
feeling that a similar issue was involved. The mother told me that her son, 19 years old
and severely
retarded, had
suffered for the previous two months, from a terrible odor all over his body. As a result,
he had been expelled from his special boarding home, and taken to a variety of specialists
including a dermatologist, allergologist. He had been put on a special diet and had lost
considerable weight. He had also spent an entire morning at a major hospital, including
consolation with the ear-nose-throat department.
Upon seeing the patient, it was immediately obvious that one of his nostrils was red and
running. The vile odor which enveloped him was 
definitely nasal in its character. I asked his
mother whether she didn't suspect his nose as the source.
"Yes", she answered, "actually one of my neighbors suggested that it might
be, but we did spend that day at the hospital, and they took an x-ray of his nasal
passages and didn't find anything." I asked her whether anybody looked up his nose.
"No", she answered, "the doctor just looked at the x-ray".
The smell was awful, and I tried to figure out whether it was coming from his nose or
whole body. The smell was strongest from his nose, but it was also strong coming from his
hands, hair and clothes. On the other hand, I did not detect odor coming from his back nor
his ankles. Clearly, the boy was taking the discharge from his nose and spreading it to
certain parts of his body. This could explain the impression that this kind of odor
appears to emanate from the entire body.
The next day the boy was sent to another ear-nose-throat specialist who removed a huge,
blackened piece of unbelievably foul-smelling paper tissue from his nose. The symptoms
disappeared immediately, and the last I heard, the family was happily back to their
routine.
