scholarly journals Primary meningococcal septic arthritis associated with joint calcium oxalate crystals: A case report and review of the literature

Author(s):  
Erik Cimé-Aké ◽  
Fabián Carranza-Enríquez ◽  
José Joel Hurtado-Arias ◽  
Wallace Rafael A Muñoz-Castañeda ◽  
Benjamín Medina-Fonseca ◽  
...  

ABSTRACT Primary meningococcal septic arthritis (PMSA) is an extremely rare local infection by Neisseria meningitidis in the absence of meningitis or meningococcaemia syndrome. A 30-year-old healthy, immunocompetent man presented with arthralgia, fever, chest rash, and significant swelling of the right knee. On admission, a disseminated maculopapular and purpuric rash, oligoarthritis, neutrophilia, and elevated acute phase reactants were documented. Following arthrocentesis of the right knee, isolation of N. meningitidis and the presence of calcium oxalate crystals in the synovial fluid were reported. The diagnosis of PMSA was made. Histological analysis of the skin lesion showed leucocytoclastic vasculitis. He was treated with intravenous ceftriaxone plus open surgical drainage and ambulatory cefixime with adequate response. After 1 month, he presented resolution of the pathological process. We performed an extensive review of the literature, finding that the key elements supporting the diagnosis of PMSA are prodromal upper respiratory tract symptoms and skin involvement prior to or synchronous with the arthritis. Also, the most frequently involved joint is the knee. This report is the first case of a patient presenting with PMSA associated with calcium oxalate crystals in the synovial fluid. Herein, we discuss the most frequent clinical manifestations, the unusual histological features, the recommended treatment, and the reported prognosis of this rare entity.

2020 ◽  
pp. 112067212095022
Author(s):  
Raoul Kanav Khanna ◽  
Adriana Ferguson ◽  
Pierre-Jean Pisella ◽  
Marie-Laure Le Lez

Introduction: Hyperoxaluria is a rare cause of hereditary crystalline retinopathy. We report the first case of acquired calcium oxalate crystalsretinopathy following domino liver transplantation (DLT). Clinical case: A 72-year-old patient was referred for bilateral visual impairment 9 months after DLT. Slit lamp examination was unremarkable. Fundus examination revealed calcium oxalate crystals accumulation within both retina. Owing to multi-organ failure, the patient underwent combined liver-kidney retransplantation. During the following two years, calcium oxalate crystals accumulation within the retina gradually decreased and visual acuity improved. Nevertheless, OCT-angiography revealed abnormalities in the inner and outer retinal vascular plexus (i.e. retinal vessels occlusion and dilatation). Visual field examination revealed bilateral constriction associated with decreased optic nerve fibre layer thickness suggesting optic nerve atrophy. Conclusion: This case highlights the need for ophthalmologists to consider the diagnosis of acquired hyperoxaluria in patients with progressive bilateral visual impairment following DLT, especially if the postoperative course is marked by renal failure. Moreover, even after liver-kidney transplantation with a conventional graft, visual function can remain impaired owing to maculopathy and optic atrophy.


Author(s):  
H. J. Arnott ◽  
M. A. Webb ◽  
L. E. Lopez

Many papers have been published on the structure of calcium oxalate crystals in plants, however, few deal with the early development of crystals. Large numbers of idioblastic calcium oxalate crystal cells are found in the leaves of Vitis mustangensis, V. labrusca and V. vulpina. A crystal idioblast, or raphide cell, will produce 150-300 needle-like calcium oxalate crystals within a central vacuole. Each raphide crystal is autonomous, having been produced in a separate membrane-defined crystal chamber; the idioblast''s crystal complement is collectively embedded in a water soluble glycoprotein matrix which fills the vacuole. The crystals are twins, each having a pointed and a bidentate end (Fig 1); when mature they are about 0.5-1.2 μn in diameter and 30-70 μm in length. Crystal bundles, i.e., crystals and their matrix, can be isolated from leaves using 100% ETOH. If the bundles are treated with H2O the matrix surrounding the crystals rapidly disperses.


1987 ◽  
Vol 65 (9) ◽  
pp. 1952-1956 ◽  
Author(s):  
J. A. Traquair

Oxalic acid and crystals of calcium oxalate were produced during growth of Leucostoma cincta and L. persoonii on potato dextrose agar and in peach bark tissues. The identification of calcium oxalate was based on solubility characteristics, the results of KMnO4 titration, positive staining with silver nitrate – dithiooxamide, and crystal morphology as observed with light and scanning electron microscopes. Oxalic acid was detected by gas chromatography. This is the first report of oxalic acid production by both Leucostoma species causing peach canker. Calcium oxalate crystals observed on or near hyphae in culture were similar to crystals in artificially inoculated peach bark tissues. Addition of oxalic acid solutions alone to inner bark tissues caused maceration and necrosis. These results indicate a role for oxalic acid in the early stages of pathogenesis by Leucostoma spp. Tetragonal (bipyramidal) and prismatic calcium oxalate crystals formed on bark wounds treated with oxalic acid solutions were similar to those observed in infected tissues and in culture media amended with oxalic acid.


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