Radiation proctitis-related lumbar spondylodiscitis due to Actinomyces odontolyticus: a rare finding

2021 ◽  
Vol 14 (7) ◽  
pp. e237047
Author(s):  
Pedro Madeira Marques ◽  
Maria Marta Quaresma ◽  
Eduardo Haghighi ◽  
José Augusto Barata
Keyword(s):  
Antibiotic Therapy ◽  
Cauda Equina ◽  
Radiation Proctitis ◽  
Lumbar Pain ◽  
Rare Finding ◽  
Therapy Regimen ◽  
Subsequent Investigation ◽  
History Of ◽  
Satisfactory Clinical Response ◽  
Purulent Drainage

Lumbar spondylodiscitis due to radiation proctitis-related fistula is a rare finding in the literature. After having isolated Actinomyces odontolyticus, a rare finding in the osteomuscular system, we present one of such cases.A 75-year-old patient with a history of rectum adenocarcinoma, submitted to surgery and radiotherapy, presented himself in our emergency department with a 3-month history of lumbar pain radiating to both legs. Physical examination was compatible with cauda equina syndrome and subsequent investigation revealed L4–L5 spondylodiscitis. Despite a 6-month antibiotic therapy regimen, the symptoms recurred. Intravertebral disc biopsy revealed A. odontolyticus and directed antibiotic therapy was started. However, the symptoms recurred after a new 6-month antibiotic therapy regimen, this time with rectal purulent drainage. Additional study revealed two rectal fistulae. It was assumed those were caused by radiation proctitis and constituted the primary cause of spondylodiscitis. Laminectomy was performed with a satisfactory clinical response.

Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 155-160
Author(s):  
Mohsen Aghapoor ◽  
◽  
Babak Alijani Alijani ◽  
Mahsa Pakseresht-Mogharab ◽  
◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
The Body ◽  
Lower Limbs ◽  
Lumbar Pain ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Death Case ◽  
Therapeutic Results ◽  
History Of ◽  
Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

Gene mutation and drug resistance of M. tuberculosis in the patients followed up in the city of Moscow

2020 ◽  
Vol 97 (12) ◽  
pp. 34-44
Author(s):  
M. A. Krasnova ◽  
E. M. Belilovsky ◽  
S. E. Borisov ◽  
A. A. Khakhalina ◽  
Yu. D. Mikhaylova ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Statistical Significance ◽  
Molecular Genetic ◽  
Previous Treatment ◽  
Repeated Treatment ◽  
Phenotypic Resistance ◽  
Therapy Regimen ◽  
Treatment History ◽  
History Of ◽  
Relationship Of

The article describes a retrospective study of the results of microbiological and molecular genetic tests of 685 M. tuberculosis cultures isolated from 685 adult tuberculosis patients registered for dispensary follow-up in Moscow in 2014.The following was identified during the study: phenotypic drug resistance (FDR) of MTB to rifampicin, isoniazid, fluoroquinolones, kanamycin, amikacin, and capreomycin in groups of patients with different treatment history; the frequency of FDR to the above anti-tuberculosis drugs in strains with mutations being drug resistance markers; the frequency of various mutations in case of FDR of mycobacteria in the patients from different groups; the relationship of FDR or the presence of a particular mutation with various characteristics of the patients and their treatment history.The history of previous treatment was determined as statistical significance to provide the greatest influence on the spread of drug resistant MTB: patients undergoing repeated treatment had FDR more often and also a much more pronounced variety of mutations being markers of FDR to certain anti-tuberculosis drugs.The results of the study showed that the detection of genetic mutations in MBT associated with FDR was a reliable tool for predicting phenotypic resistance and should be used as the main method for selecting anti-tuberculosis drugs when compiling the etiotropic therapy regimen.

scholarly journals Intradural Spinal Metastasis from Renal Cell Carcinoma: A Case Report

2001 ◽  
Vol 9 (2) ◽  
pp. 57-61 ◽  
Author(s):  
Kan-Hing Mak ◽  
John Ching-Kwong Kwok
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Spinal Metastasis ◽  
Cauda Equina ◽  
History Of ◽  
Epidural Metastasis ◽  
Cauda Equina Lesion ◽  
Osseous Structure ◽  
Intradural Space

Intradural spinal metastasis is rare. This is the third case ever reported on the finding of intradural spinal metastasis from a renal cell carcinoma that had been removed surgically. The patient had a history of epidural metastasis for which excision and anterior stabilization were done 3 years before the new presentation with cauda equina lesion. Seeding from the involved osseous structure to the cerebrospinal fluid through the dura was believed to be the course that tumour had taken to reach the intradural space.

scholarly journals Community-Acquired MRSA Pyomyositis: Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Douglas P. Olson ◽  
Sarita Soares ◽  
Sandhya V. Kanade
Keyword(s):  
Epidural Abscess ◽  
Surgical Intervention ◽  
Cauda Equina ◽  
Spinal Epidural Abscess ◽  
Paraspinal Muscles ◽  
Sensory Deficits ◽  
Antibiotic Management ◽  
History Of ◽  
Spinal Epidural ◽  
Repeat Imaging

Community-acquired methicillin-resistantStaphylococcus aureus(CA-MRSA) is responsible for a broad range of infections. We report the case of a 46-year-old gentleman with a history of untreated, uncomplicated Hepatitis C who presented with a 2-month history of back pain and was found to have abscesses in his psoas and right paraspinal muscles with subsequent lumbar spine osteomyelitis. Despite drainage and appropriate antibiotic management the patient's clinical condition deteriorated and he developed new upper extremity weakness and sensory deficits on physical exam. Repeat imaging showed new, severe compression of the spinal cord and cauda equina from C1 to the sacrum by a spinal epidural abscess. After surgical intervention and continued medical therapy, the patient recovered completely. This case illustrates a case of CA-MRSA pyomyositis that progressed to lumbar osteomyelitis and a spinal epidural abscess extending the entire length of the spinal canal.

scholarly journals Post-traumatic pseudolipoma of the forehead

2007 ◽  
Vol 15 (3) ◽  
pp. 173-174 ◽  
Author(s):  
David Horovitz ◽  
Damir B Matic
Keyword(s):  
Subcutaneous Tissue ◽  
Clinical Findings ◽  
Frontal Bone ◽  
Forceps Delivery ◽  
Resonance Imaging ◽  
Frontalis Muscle ◽  
Rare Finding ◽  
History Of ◽  
Post Traumatic ◽  
Fibrofatty Tissue

A forehead lipoma is a rare finding in a child, and one that penetrates the underlying layers of muscle and bone to attach to dura has not previously been reported. Two such cases, both in children who underwent uneventful deliveries aided by forceps, are presented. Both lesions were present at birth and, based on clinical findings, were originally thought to be dermoid cysts. Dermoid cysts could not be ruled out with computed tomography and magnetic resonance imaging. Histopathology identified fibrofatty tissue consistent with lipoma. Both lesions extended from the subcutaneous tissue through the frontalis muscle and frontal bone to the dura. Given these findings and the history of forceps delivery, the most likely diagnosis is posttraumatic pseudolipoma. This lesion should be considered in the differential diagnosis of congenital lesions of the forehead, particularly if there is a history of forceps delivery or other trauma to the area.

scholarly journals Spontaneous Rupture of Urinary Bladder: Two Case Reports and Review of Literature

2021 ◽  
Vol 8 ◽  
Author(s):  
Yue Zhang ◽  
Shuo Yuan ◽  
Rami W. A. Alshayyah ◽  
Wankai Liu ◽  
Yang Yu ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Urinary Bladder ◽  
Antibiotic Therapy ◽  
Acute Abdomen ◽  
Spontaneous Rupture ◽  
Bladder Tumor ◽  
Bladder Rupture ◽  
Intraperitoneal Rupture ◽  
History Of ◽  
Ct Cystography

Objectives: Spontaneous rupture of the urinary bladder (SRUB) is extremely rare and might be misdiagnosed, leading to a high mortality rate. The current study aimed to identify the cause, clinical features, and diagnosis strategy of SRUB.Methodology: We presented a case report for two women (79 and 63 years old) misdiagnosed with acute abdomen and acute kidney injury, respectively, who were finally confirmed to have SRUB by a series of investigations and exploratory surgery. Meanwhile, literature from multiple databases was reviewed. PubMed, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biological Medical Literature Database (CBM), WANFANG DATA, and the Chongqing VIP database for Chinese Technical Periodicals (VIP) were searched with the keywords “spontaneous bladder rupture” or “spontaneous rupture of bladder” or “spontaneous rupture of urinary bladder.” All statistical analyses were conducted using SPSS 20.0 software.Results: A total of 137 Chinese and 182 English literature papers were included in this article review. A total of 713 SRUB patients were analyzed, including the two patients reported by us. The most common cause of SRUB was alcohol intoxication, lower urinary tract obstruction, bladder tumor or inflammation, pregnancy-related causes, bladder dysfunction, pelvic radiotherapy, and history of bladder surgery or bladder diverticulum. Most cases were diagnosed by exploratory laparotomy and CT cystography. Patients with extraperitoneal rupture could present with abdominal pain, abdominal distention, dysuria, oliguria or anuria, and fever. While the main symptoms of intraperitoneal rupture patients could be various and non-specific. The common misdiagnoses include acute abdomen, inflammatory digestive disease, bladder tumor or inflammation, and renal failure. Most of the patients (84.57%) were treated by open surgical repair, and most of them were intraperitoneal rupture patients. Overall, 1.12% of patients were treated by laparoscopic surgery, and all of them were intraperitoneal rupture patients. Besides, 17 intraperitoneal rupture patients and 6 extraperitoneal rupture patients were treated by indwelling catheterization and antibiotic therapy. Nine patients died of delayed diagnosis and treatment.Conclusions: SRUB often presents with various and non-specific symptoms, which results in misdiagnosis or delayed treatment. Medical staff noticing abdominal pain suggestive of peritonitis with urinary symptoms should be suspicious of bladder rupture, especially in patients with a history of bladder disease. CT cystography can be the best preoperative non-invasive examination tool for both diagnosis and evaluation. Conservative management in the form of urine drainage and antibiotic therapy can be used in patients without severe infection, bleeding, or major injury. Otherwise, surgical treatment is recommended. Early diagnosis and management of SRUB are crucial for an uneventful recovery.

scholarly journals Hypertrophic Osteoarthropathy: A Secondary Manifestation of Malignant Melanoma

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Shiva Malaty ◽  
Aditya Gupta
Keyword(s):  
Metastatic Melanoma ◽  
Plain Film ◽  
Hypertrophic Osteoarthropathy ◽  
Imaging Studies ◽  
Case Presentation ◽  
Rare Finding ◽  
Presenting Symptoms ◽  
Lung Malignancies ◽  
History Of

Background. Hypertrophic osteoarthropathy (HOA) is a rare finding in the setting of metastatic melanoma. A majority of cases of secondary HOA involve lung malignancies. Evaluation of presenting symptoms such as polyarthralgia and clubbing followed by review of imaging studies are diagnostic steps for HOA. Case Presentation. We present a 60-year-old female with a history of metastatic melanoma who presented with bilateral and symmetric polyarthralgia and clubbing. A plain film radiograph demonstrated periosteal thickening involving the metacarpals and proximal phalanges as well as the distal radius and ulna, consistent with HOA. The patient was treated with nonsteroidal anti-inflammatory agents for supported care. Conclusion. HOA may be a secondary manifestation of metastatic melanoma. Recognition and supportive care of this condition may lead to improved quality of life for patients.

scholarly journals A case of retroperitoneal tumor – clinical and therapeutic considerations

2016 ◽  
Vol 22 (3) ◽  
pp. 203-207
Author(s):  
R. Osman ◽  
V. Sarbu ◽  
S. Osman
Keyword(s):  
Rare Condition ◽  
Surgical Excision ◽  
Retroperitoneal Tumor ◽  
Lumbar Pain ◽  
Pathological Examination ◽  
Nerve Sheath Tumor ◽  
Abdominal Girth ◽  
Computed Tomographic ◽  
Appropriate Treatment ◽  
History Of

Abstract Introduction: The aim of this paper is to present a case of rare retroperitoneal tumor. Material and Methods. A 72 year old man presented with six month history of abdominal girth, lumbar pain and occasional episodes of constipation was admitted in our clinic. A computed tomographic abdominal scan revealed a retroperitoneal solid mass. Surgical exploration performed later displayed solid and well delimited mass throughout retroperitoneal space followed by excision of lesion and multiple drainages. Microscopic pathological examination was benign nerve sheath tumor. Conclusion. These tumors are characteristically firm, smooth, and asymptomatic. They range in size from 1-2 mm to over 20 cm. Awareness of this indolent and rare condition is an important prerequisite for early diagnosis and appropriate treatment. Surgical excision can usually be accomplished by enucleating of the tumor without damage to the adjacent nerve.

THE NATURAL HISTORY OF INTERMITTENT CLAUDICATION OF THE CAUDA EQUINA

Brain ◽  
1978 ◽  
Vol 101 (2) ◽  
pp. 211-222 ◽  
Author(s):  
J.N. BLAU ◽  
VALENTINE LOGUE
Keyword(s):  
Natural History ◽  
Intermittent Claudication ◽  
Cauda Equina ◽  
History Of

Review and retrospective analysis of degenerative lumbosacral stenosis in 156 dogs treated by dorsal laminectomy

2008 ◽  
Vol 21 (03) ◽  
pp. 285-293 ◽  
Author(s):  
N. Suwankong ◽  
G. Voorhout ◽  
A. de Boer ◽  
H. Hazewinkel ◽  
B. Meij
Keyword(s):  
Medical Records ◽  
Joint Angle ◽  
Facet Joint ◽  
Cauda Equina ◽  
Clinical Signs ◽  
Clinical Findings ◽  
Lumbar Pain ◽  
German Shepherd ◽  
Disc Protrusion ◽  
German Shepherd Dog

SummaryThe medical records of 156 dogs with degenerative lumbosacral stenosis (DLS) that underwent decompressive surgery were reviewed for signalment, history, clinical signs, imaging and surgical findings. The German Shepherd Dog (GSD) was most commonly affected (40/156, 25.6%). Pelvic limb lameness, caudal lumbar pain and pain evoked by lumbosacral pressure were the most frequent clinical findings. Radiography showed lumbosacral step formation in 78.8% (93/118) of the dogs which was associated with elongation of the sacral lamina in 18.6% (22/118). Compression of the cauda equina was diagnosed by imaging (epidurography, CT, or MRI) in 94.2% (147/156) of the dogs. Loss of the bright nucleus pulposus signal of the L7-S1 disc was found on T2-weighted MR images in 73.5% (25/34) of the dogs. The facet joint angle at L7-S1 was significantly smaller, and the tropism greater in GSD than in the other dog breeds. The smaller facet joint angle and higher incidence of tropism seen in the GSD may predispose this breed to DLS. Epidurography, CT, and MRI allow adequate visualization of cauda equina compression. During surgery, disc protrusion was found in 70.5% (110/156) of the dogs. Overall improvement after surgery was recorded in the medical records in 79.0% (83/105) of the dogs. Of the 38 owners that responded to questionnaires up to five years after surgery, 29 (76%) perceived an improvement.

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