scholarly journals P26 Case of atypical cutaneous Mycobacterium chelonae infection in a patient with SLE after cyclophosphamide therapy

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Sheraz Rasool ◽  
Amr Afifi ◽  
Denise De Lord
Keyword(s):  
Peripheral Neuropathy ◽  
Antimicrobial Agents ◽  
Cord Compression ◽  
Cervical Cord ◽  
Close Monitoring ◽  
Disc Disease ◽  
Mycobacterium Chelonae ◽  
Canal Stenosis ◽  
The Right ◽  
High Index Of Suspicion

Abstract Background Mycobacterium chelonae is a rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infection has been reported associated with surgical and cosmetic procedures. Disseminated infection is rare and usually occurs in individuals who are immunocompromised. We present a patient with severe SLE on immunosuppressive therapy who developed localised severe cutaneous infection of the foot. Methods A 69-year-old lady with complex SLE - RNP+, Raynaud's, arthritis, stable for several years had deteriorated within the last year with cardiac myositis and, peripheral neuropathy. Three months pulsed intravenous cyclophosphamide (EUROLUPUS regime) was completed in November 2018. Five weeks later she developed severe pain, inability to weight-bear and extensive erythema and swelling of the right ankle and lower leg. An MRI showed extensive skin thickening especially dorsally in the R foot and anteriorly in distal leg. There was also increased signal in the distal achilles tendon. Orthopedic review confirmed no evidence of septic arthritis or osteomyelitis. A skin biopsy was performed, cultures from which grew Mycobacterium chelonae. She was admitted and started on tobramycin, on which she developed long QTc, linezolid which caused thrombocytopenia and clarithromycin. In March 2019 she was re-admitted with confusion, weakness and AKI, secondary to clarithromycin. She was, then switched to clofazimine and low dose clarithromycin, on which she was stabilized. MRI brain scan was normal, lumbar puncture was negative for M chelonae PCR and MRI spine confirmed cervical cord compression and cervical and lumbar canal stenosis due to osteophytes and disc disease. Results The infection improved considerably after 5 months of successful mycobacterial treatment. It was then possible to treat with rituximab for a deteriorating peripheral neuropathy confirmed on EMG and cardiac myositis. Sadly, whilst awaiting rehabilitation, the patient died unexpectedly in April 2019 from an arrhythmia. Conclusion Mycobacterium chelonae is an uncommon cause of soft tissue infection, which is resistant to all anti-tuberculous drugs. It is susceptible to a wider range of antimicrobial agents including tobramycin, imipenem, clarithromycin, linezolid, co-trimoxazole. A high index of suspicion is necessary for diagnosis, particularly in immunocompromised patients. The incidence may be increasing, possibly due to enhanced detection. Infection can mimic MSK presentations including capsulitis, tendonitis and tenosynovitis. Close monitoring is required as anti-microbial therapy complications are common including prolongation of QTc on tobramycin. Vigilance for disseminated multiorgan involvement is essential due to high mortality, particularly with CNS and lung involvement. Atypical infections should always be considered in the immunocompromised, particularly mycobacteria, nocardia & fungi. Disclosures S. Rasool None. A. Afifi None. D. De Lord None.

scholarly journals Intramedullary Cervical Tuberculoma: A Case Report With Note on Surgical Management

2015 ◽  
Vol 100 (1) ◽  
pp. 133-136 ◽  
Author(s):  
Hong-Bin Ju ◽  
Dong-Ming Guo ◽  
Fan-Fan Chen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Previous History ◽  
Mass Effect ◽  
Cord Compression ◽  
Cervical Cord ◽  
Resonance Imaging ◽  
Intramedullary Lesion ◽  
The Right

Abstract This study aims to report a relatively rare entity—intramedullary tuberculum of cervical spine—and describe its management and some key learning points. Intramedullary tuberculomas are rare entities. Intramedullary tuberculoma is most commonly found in the thoracic cord of a patient and is rarely seen in the cervical cord. We present an intramedullary cervical tuberculoma in a 21-year-old patient with finding of spinal cord compression. All 4 limbs were spastic, with grade 1 power on the right side and grade 3 power on the left side. Sensory deficit was found below the C6 level. Magnetic resonance imaging showed an intramedullary lesion at the C5 to C6 levels. Intramedullary tuberculoma was diagnosed based on clinical symptoms, physical examination, previous history, and magnetic resonance imaging. A C5 to C7 laminectomy was performed. Intramedullary tuberculoma was resected by microsurgery. One year after the surgery, strength returned to normal grade 5. Excellent clinical outcome was obtained with a combination of both medical and surgical treatments. Intramedullary cervical tuberculoma should be removed without delay to eliminate any mass effect on the neurons as soon as possible.

scholarly journals Report of a case of Cobb syndrome: multimodality imaging

2020 ◽  
pp. 20200145
Author(s):  
Dalia Ibrahim ◽  
Shady Mashhour
Keyword(s):  
Upper Limb ◽  
Vascular Malformations ◽  
Multimodality Imaging ◽  
Skin Lesions ◽  
Cord Compression ◽  
Low Flow ◽  
Vascular Lesions ◽  
Cervical Cord ◽  
Limb Weakness ◽  
The Right

Cobb syndrome is a rare vascular disorder characterized by vascular skin lesions distributed in a dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). We present a case of a 25-year-old man who presented with a history of right upper limb paresthesia followed by bilateral progressive upper and lower limb weakness and heaviness. Physical examination showed large cutaneous port wine stains on the right side of the chest, the nape, and along the whole right upper limb in a dermatomal distribution, with no corresponding limb hypertrophy or asymmetry. MRI and CT scan of the cervical spine showed aggressive vertebral hemangiomas involving the right side of C1 down to C4 vertebrae associated with extraosseous epidural lesion causing cervical cord compression, in addition to right paraspinal muscular low flow vascular malformations. Digital subtraction angiography of the neck vessels showed corresponding vascular blush and delayed contrast pooling in the affected regions. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. The patient underwent a decompressive laminectomy at C2–C6 levels with removal of the epidural lesion, after which his symptoms had improved.

Cervical flexion myelopathy: a “tight dural canal mechanism”

1987 ◽  
Vol 66 (6) ◽  
pp. 935-937 ◽  
Author(s):  
Yoshinobu Iwasaki ◽  
Kunio Tashiro ◽  
Seiji Kikuchi ◽  
Mayumi Kitagawa ◽  
Toyohiko Isu ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Cord Compression ◽  
Cervical Cord ◽  
Posterior Border ◽  
Disc Disease ◽  
Content Type ◽  
Neuroradiological Examination ◽  
Cervical Flexion Myelopathy ◽  
Progressive Weakness ◽  
Fine Print

✓ The authors describe a case of flexion myelopathy due to specific morphological changes of the cervical cord, termed a “tight dural canal mechanism.” The patient was an 18-year-old man with progressive weakness and muscle atrophy of the left arm. Neuroradiological examination revealed that the lower cervical cord was compressed during flexion of the cervical spine, but that there was no disc disease or cervical vertebral instability. The cord compression was attributed to a pinching mechanism by the posterior border of the vertebral body and the posterior component of the dura on flexion.

scholarly journals Spindle Cell Melanoma Presenting as an Ulcer in a Black Diabetic

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
D. A. Gaskin ◽  
D. Brathwaite ◽  
N. Depeiza ◽  
P. S. Gaskin ◽  
J. Ward
Keyword(s):  
Peripheral Neuropathy ◽  
Primary Care Physicians ◽  
Spindle Cell ◽  
Histological Evaluation ◽  
Brown Pigment ◽  
Ulcer Case ◽  
Diabetic Ulcer ◽  
Short Disease Duration ◽  
The Right ◽  
High Index Of Suspicion

Background. Melanoma in blacks is uncommon and exceedingly rare in association with a diabetic ulcer. We present a case of a spindle cell melanoma masquerading as a diabetic ulcer. Case Report. A 57-year-old overweight woman presented to The Maria Holder Diabetes Centre for the Caribbean with a nonhealing ulcer of the right heel after being treated by various primary care physicians over the preceding year. Her general and systematic examinations were unremarkable. There was a 1 × 1.5  cm ulcer with a necrotic base which bled easily on contact with no evidence of peripheral neuropathy nor arterial insufficiency. Microscopic examination of a biopsy of the lesion showed fascicles of spindle cells with plump nuclei and intracytoplasmic yellow-brown pigment. Immunohistochemistry confirmed a diagnosis of melanoma. Discussion. There should be a high index of suspicion of malignancy with nonhealing diabetic ulcer especially when coupled with short disease duration. This case highlights the importance of a biopsy and histological evaluation in ulcers presenting in recently diagnosed diabetics with no evidence of peripheral neuropathy or vascular disease. Melanoma should be considered in spindle cell lesions especially with pigment and residual nevus cells.

scholarly journals 735 An Unusual Case of Cervical Potts Disease in A Pediatric Patient

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Pandya ◽  
A Shogan
Keyword(s):  
Extrapulmonary Tuberculosis ◽  
Compression Fracture ◽  
Cord Compression ◽  
Cervical Cord ◽  
Lumbar Region ◽  
Tissue Mass ◽  
Pott’S Disease ◽  
Canal Stenosis ◽  
Body Fracture ◽  
Oral Biopsy

Abstract Pott’s disease is a form of extrapulmonary tuberculosis (TB) affecting the spine. Approximately 10% of individuals with extrapulmonary TB will have skeletal manifestations with the most common area affected being the spine, followed by the hip and knee. Within the spine, Pott’s disease has a predilection for affecting the thoraco-lumbar region, with the cervical spine being the least affected. Here, we report a case of cervical Pott’s disease in a 16-year-old child, with no risk factors for TB, presenting with neck pain and stiffness. Initial blood results were unremarkable, but a CT scan showed a C5 vertebral body fracture and mild canal stenosis. A sagittal MRI scan demonstrated canal stenosis and a pathologic compression fracture of the C5 vertebrae, a soft tissue mass extending into the epidural and prevertebral spaces and associated cervical cord compression. A trans-oral biopsy confirmed TB and a diagnosis of Pott’s disease. She underwent HALO placement and needed further fusion surgery. She was started on anti-tuberculous therapy and made a good recovery post-operatively.

Vacuum phenomenon associated with triple cervical vertebral arch and ligamentum flavum anomaly resulting in severe stenotic myelopathy in a dog

2019 ◽  
Vol 88 (1) ◽  
pp. 29-33
Author(s):  
S. Vermeire ◽  
V. Rondahl ◽  
H. Schmökel ◽  
M. Rapp
Keyword(s):  
Ligamentum Flavum ◽  
Cord Compression ◽  
Intervertebral Discs ◽  
Cervical Canal ◽  
Canal Stenosis ◽  
Pelvic Limb ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Compressive Myelopathy ◽  
Vertebral Arch

A six-year-old American Staffordshire terrier with proprioceptive deficits of the right thoracic and pelvic limb was referred for further work-up. Cervical computed tomography (CT) and magnetic resonance imaging (MRI) revealed a triple cervical canal stenosis with dorsal spinal cord compression and concomitant compressive myelopathy caused by vertebral arch and ligamentum flavum proliferation and hypertrophy. Vacuum phenomena were noticed within the ligamentum flavum tissue, a previously unreported location for vacuum phenomena, which are primarily reported within degenerative joints and intervertebral discs. Decompressive surgery and rehabilitation resulted in a complete clinical recovery.

Chronic tophaceous gout mimicking widespread metastasis

2021 ◽  
Vol 14 (5) ◽  
pp. e236166
Author(s):  
Joshua W Thompson ◽  
Sriram Srinivasan ◽  
Damodar Makkuni
Keyword(s):  
Differential Diagnosis ◽  
Axial Skeleton ◽  
Cord Compression ◽  
Initial Assessment ◽  
Appendicular Skeleton ◽  
Tophaceous Gout ◽  
Correct Treatment ◽  
Canal Stenosis ◽  
The Right ◽  
The Masses

Gout is a common crystal-induced arthropathy affecting mainly the joints of the appendicular skeleton; however, rarely this condition affects the axial skeleton as well. Spinal gout can cause radiculopathy, cord compression, canal stenosis and discitis. We describe a case of a 71-year-old woman where the initial presentation of destructive arthropathy and spinal masses secondary to axial gout was mistaken for a metastatic malignancy. Despite chronic polyarthropathy and bilateral subcutaneous gouty tophi, spinal gout was not considered a differential diagnosis during initial assessment.The patient was managed conservatively with pharmacological treatment resulting in improvement of her upper limb radiculopathy and systemic joint pain, although little improvement in mobility. Such extensive involvement is rare and the masses can mimic an underlying metastatic disease. Careful history and clinical examination recognising polyarthropathy and subcutaneous tophi can aid the clinician to make the right diagnosis and institute correct treatment. Delay in recognising gout as a differential diagnosis can lead to marked morbidity as illustrated in our case.

Cervical Spinal Cord Compression Attributable to a Calcified Intervertebral Disc in a Patient with X-linked Hypophosphatemic Rickets: Case Report and Review of the Literature

Neurosurgery ◽  
2002 ◽  
Vol 51 (1) ◽  
pp. 239-243 ◽  
Author(s):  
Martin Soehle ◽  
Adrian T.H. Casey
Keyword(s):  
Spinal Cord ◽  
Intervertebral Disc ◽  
Spinal Cord Compression ◽  
Spinal Canal ◽  
Facet Joint ◽  
Cord Compression ◽  
Spinal Canal Stenosis ◽  
Hypophosphatemic Rickets ◽  
Cervical Cord ◽  
Canal Stenosis

Abstract OBJECTIVE AND IMPORTANCE X-linked hypophosphatemic rickets is a common inherited phosphate-wasting disorder, but it is a rare cause of spinal cord compression. We present the first reported case of a calcified intervertebral disc causing spinal canal stenosis in X-linked hypophosphatemic rickets. CLINICAL PRESENTATION A 44-year-old woman presented with paresthesia of her left arm and a loss of grip in both hands. Magnetic resonance imaging revealed a calcified intervertebral disc, as well as a posterior osteophytic bar causing marked cervical cord compression at C6/C7. INTERVENTION An anterior cervical discectomy at C6/C7 and fusion with autologous bone graft were performed. The patient then exhibited significant improvement. CONCLUSION A review of the 16 published cases demonstrates that thickening of the vertebral laminae, facet joint hypertrophy, and ossification of the intervertebral discs, posterior longitudinal ligament, and/or ligamentum flavum contribute to spinal canal stenosis in X-linked hypophosphatemic rickets. Those changes are caused by the disease itself and are unlikely to be related to long-term vitamin D treatment. Eleven of 16 patients were reported to have experienced favorable outcomes after surgery.

The value of real-time ultrasound-guidance for definite placement of a right supraclavicular subclavian central venous catheter

2021 ◽  
pp. 112972982199853
Author(s):  
Jens M Poth ◽  
Stefan F Ehrentraut ◽  
Se-Chan Kim
Keyword(s):  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Needle Insertion ◽  
Major Surgery ◽  
Axillary Vein ◽  
Central Venous ◽  
Supraclavicular Fossa ◽  
The Right ◽  
High Index Of Suspicion ◽  
Insertion Process

Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications. Here, we describe a case in which misplacement of a guidewire following infraclavicular puncture of the right axillary vein was detected by continuous ultrasound employing the right supraclavicular fossa view. Utilizing this ultrasound view, the insertion approach to the vessel was changed and correct CVC placement could be achieved. While ultrasound guidance is widely accepted for vessel puncture, this case demonstrates the value of continuous ultrasound guidance for the entire process of CVC insertion: vessel puncture, correct guidewire advancement, catheter placement, and exclusion of complications such as pneumothorax. It also shows that there should be a high index of suspicion for guidewire misplacement, even after successful venipuncture. In conclusion, ultrasound protocols covering the complete CVC insertion process should be implemented into current clinical practice.

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