Rare, post-periodontitis spondylodiscitis caused by Fusobacterium nucleatum in a patient with multiple sclerosis: challenge of diagnosis and treatment

Fusobacterium nucleatum is part of the commensal flora of the oral cavity, frequently associated with periodontal infections. We describe the case of a 49-year-old woman, on immunsuppressive therapy for multiple sclerosis, who presented with a 3-month history of debilitating back pain. She had a recent episode of periodontitis, and was under regular dental review. Her MRI scan demonstrated findings suggestive of L2–L3 spondylodiscitis. Her CT-guided biopsy yielded negative cultures and the patient failed two courses of empirical antibiotic treatment. With clinical and radiological disease progression, she underwent a percutaneous disc washout and biopsy, which subsequently grew F. nucleatum. Treatment with clindamycin and metronidazole was commenced orally for 6 weeks. She improved gradually, and at 1 year follow-up was asymptomatic. The diagnosis of spondylodiscitis caused by F. nucleatum is challenging. The perseverance on identification by surgical biopsy, minimally invasive washout and targeted antibiotics are the mainstay of effective treatment.

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Concomitant hepatic tuberculosis and hepatocellular carcinoma: a case report and review of the literature

BMC Surgery ◽

10.1186/s12893-020-01021-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hind S. Alsaif ◽

Ali Hassan ◽

Osamah Refai ◽

Khaled Awary ◽

Haitham Kussaibi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Malignancy ◽

Ct Guided ◽

Case Presentation ◽

Hepatic Tuberculosis ◽

Ct Guided Biopsy ◽

History Of ◽

Abdominal Examination ◽

Peripheral Arterial ◽

High Index Of Suspicion

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. Case presentation We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis. Conclusion A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

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A Case of Radiation Fibrosis Appearing as Mass-Like Consolidation after SBRT with Elevation of Serum CEA

Case Reports in Medicine ◽

10.1155/2010/986706 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Kotaro Terashima ◽

Yoshiyuki Shioyama ◽

Satoshi Nomoto ◽

Saiji Ohga ◽

Takeshi Nonoshita ◽

...

Keyword(s):

Local Recurrence ◽

Short Interval ◽

Primary Lung Cancer ◽

Dorsal Side ◽

Ct Guided ◽

Radiation Fibrosis ◽

Ct Guided Biopsy ◽

Serum Cea ◽

The Right

We report a case of radiation fibrosis appearing as mass-like consolidation, which was difficult to distinguish from local recurrence. A 72-year-old woman was diagnosed as having primary lung cancer (cT1N0M0 stage IA) in the right upper lobe and was treated with SBRT of 48 Gy in 4 fractions. After 12 months, mass-like consolidation appeared around the irradiated area, and after 13 months, it had increased in size. FDG-PET revealed high uptake (SUVmax=5.61) for the consolidation. CT-guided biopsy was performed, but we could not confirm the diagnosis. Considering her poor respiratory function and her age, short-interval follow-up was performed. After 15 months, the consolidation enlarged at the dorsal side, and carcinoembryonic antigen (CEA) became elevated (14.6 ng/mL). Serum KL-6 (436 U/mL) and SP-D (204 ng/mL) were also elevated. However, after 16 months, serum CEA slightly decreased. The consolidation gradually retracted on follow-up CT images. CEA, KL-6, and SP-D were also decreased by degrees. After 40 months, there is no evidence of local recurrence.

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Aggressive Vertebral Hemangiomas Causing Compression Fracture with Neurological Deficits: A Retrospective Cohort Study

10.21203/rs.3.rs-25626/v1 ◽

2020 ◽

Author(s):

Hongming Rao ◽

Guishuang Li ◽

Limin Liu ◽

Yuming Huang ◽

Zhengquan Xu ◽

...

Keyword(s):

Clinical Outcomes ◽

Body Height ◽

Compression Fracture ◽

Neurological Deficits ◽

Ct Guided ◽

Guided Biopsy ◽

Estimated Blood Loss ◽

Ct Guided Biopsy ◽

Vertebral Hemangiomas

Abstract Background:In rare instances, aggressive vertebral hemangiomas (VHs) can cause compression fracture, resulting in severe pain and neurological deficits. But the diagnosis and treatment of these aggressive lesions are challenging because of these lesions are rare and atypical. This study aimed to evaluate the safety and efficacy of surgical management for aggressive VHs with vertebral compression fracture by a modified multimodality surgery.Methods:We retrospectively reviewed 6 cases suffering from aggressive VHs with compression fracture and neurological deficits in our department from July 2011 to April 2016. These patients were treated by the multimodality surgery, includingpreoperative embolization, intraoperative injection of gelfoam mixed with cement, and laminectomy decompression.The follow-up period was at least 3 years. Perioperative parameters, clinical outcomes, and radiographical data were collected and analyzed.Results: The 6 patients involved 1 male and 5 females (mean age, 52.3 years).The levels involved were: in thoracic spine (5 cases) and lumbar spine (1 case).Preoperative CT-guided biopsy was conducted in all patients, with 5 patients had definitive pathologic diagnosis. All patients were treated successfully with the multimodal surgery, with no cement leakage and other severe complications. The mean operation time was 182.2 minutes, and the estimated blood loss was 908.3 ml.At an average follow-up of 49.8 months, clinical outcomes assessed by the visual analogue scale and Frankel grade were significantly improved. The vertebral body height and kyphosis angle of the fractured vertebra were also corrected postoperatively. No affected vertebra re-fracture and adjacent vertebral fracture were developed, and none of the patients experienced recurrence of tumor at final follow-up.Conclusions:In cases of aggressive VHs causing compression fracture with neurological deficits, CT-guided biopsy is indicated for the diagnosis. The multimodality surgery (preoperative embolization, intraoperative injection of gelfoam mixed with bone cement combined laminectomy decompression) is effective and safe, and can be considered as an acceptable surgical choice.

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Laryngeal gout mimicking chondrosarcoma with concurrent longus colli tendinitis

BMJ Case Reports ◽

10.1136/bcr-2019-231070 ◽

2019 ◽

Vol 12 (10) ◽

pp. e231070

Author(s):

Si Ying Chrisanda Lee ◽

Yijin Jereme Gan ◽

Julian Park Nam Goh ◽

Yong Howe Ho ◽

Ming Yann Lim

Keyword(s):

Ct Scan ◽

Thyroid Cartilage ◽

Open Biopsy ◽

Mri Scan ◽

Ct Guided ◽

Standardised Uptake Value ◽

Positron Emission ◽

Longus Colli ◽

Ct Guided Biopsy ◽

The Right

A 42-year-old man with multiple comorbidities, including gout, presented to the emergency department with severe odynophagia for 4 days with intermittent dysphagia for 1–2 months. A CT scan of the neck showed right longus colli tendinitis and partially calcified excrescences from the right thyroid cartilage which raised suspicion of a cartilaginous tumour. He underwent an MRI scan of the neck to better evaluate the thyroid cartilage findings, which showed a heterogeneous mass suspicious for a chondroid tumour. He then underwent a positron-emission tomography-CT scan which showed a fluorodeoxyglucose-avid mass containing foci of calcification involving the right thyroid cartilage and adjacent strap muscle, with high standardised uptake value of 7.7. He subsequently underwent a CT-guided biopsy and an open biopsy of the right thyroid cartilage, and the results revealed gouty tophi. To our knowledge, this is the first reported case of laryngeal gout with longus coli tendinitis, both of which are rare conditions.

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Detection of a new melanoma in a patient treated with fingolimod

BMJ Case Reports ◽

10.1136/bcr-2018-227951 ◽

2019 ◽

Vol 12 (4) ◽

pp. e227951 ◽

Cited By ~ 3

Author(s):

Yves Michiels ◽

Olivier Bugnon ◽

Jean-François Michiels ◽

Sophie Mazellier

Keyword(s):

Multiple Sclerosis ◽

Sun Exposure ◽

Superficial Spreading ◽

Brown Hair ◽

Skin Cancers ◽

Relapsing Remitting ◽

History Of ◽

Blue Eyes ◽

Relapsing Remitting Multiple Sclerosis

In addition to the TRANSFORMS, FREEDOMS, INFORMS studies, very few publications have identified new cases of skin cancer in patients treated with fingolimod. Here, we present the case of a 52-year-old Caucasian patient with relapsing remitting multiple sclerosis for 19 years, with a phototype II with blue eyes, light brown hair, no personal or family history of melanoma and a low number of naevi (<10). She did not experience intense sun exposure in childhood as well as severe sunburn and did not practise sessions in ultraviolet cabins. This case is distinguished from other published cases, usually superficial spreading malignant melanoma by its unclassifiable histological character. The occurrence of skin cancers in patients with multiple sclerosis remains exceptional, but new cases have recently emerged requiring the strengthening of dermatological follow-up of such patients.

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The Natural History of Multiple Sclerosis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100026573 ◽

1987 ◽

Vol 14 (3) ◽

pp. 255-261 ◽

Cited By ~ 86

Author(s):

B.G. Weinshenker ◽

G.C. Ebers

Keyword(s):

Multiple Sclerosis ◽

High Risk ◽

Natural History ◽

Prospective Studies ◽

Rapid Development ◽

Clinical Markers ◽

Inception Cohort ◽

Natural History Studies ◽

History Of

ABSTRACT:Studies which have attempted to define the outcome of multiple sclerosis (MS) have methodologic difficulties arising from patient referral biases and the length of follow-up required, which make prospective studies of an inception cohort unrealistic. Means to improve the validity of retrospective natural history studies are suggested. Results of existing series are summarized and compared. Survival is only rarely shortened by MS, but disability to the point of requiring aids for ambulation occurs in 30-70% of patients by 15 years from onset of symptoms. Disagreement as to the percentage of patients who are ultimately bedridden by MS likely arises in large part due to differences in patient ascertainment and follow-up. The need to develop early clinical markers for the patient at high risk for rapid development of major disability is stressed.

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Tuberculous Spondylitis of the Craniovertebral Junction

Journal of Bone and Joint Infection ◽

10.7150/jbji.15884 ◽

2016 ◽

Vol 1 (1) ◽

pp. 31-33 ◽

Cited By ~ 1

Author(s):

Panayiotis D. Megaloikonomos ◽

Vasilios Igoumenou ◽

Thekla Antoniadou ◽

Andreas F. Mavrogenis ◽

Konstantinos Soultanis

Keyword(s):

Craniovertebral Junction ◽

Tuberculous Spondylitis ◽

Mycobacterium Tuberculosis Infection ◽

Halo Vest ◽

Ct Guided ◽

Antituberculous Treatment ◽

Ct Guided Biopsy ◽

Bony Lesions ◽

Infection Recurrence

Abstract. Craniovertebral junction tuberculosis is rare, accounting for 0.3 to 1% of all tuberculous spondylitis cases. MR imaging is the modality of choice to detect bone involvement, abscess formation and subligamentous spreading of the pus, to differentiate from other lesions affecting the craniovertebral junction, and to determine the efficacy of treatment. Given the fact that surgical treatment of patients with craniovertebral junction tuberculosis has been associated with a high mortality rate ranging up to 10% and recurrence rate ranging up to 20%, conservative is the standard of treatment for most patients.This article presents a patient with craniovertebral junction Mycobacterium tuberculosis infection diagnosed with CT-guided biopsy. A halo vest was applied and antituberculous treatment with rifampicin, isoniazid and ethambutol was initiated. At 6-month follow-up, the patient was asymptomatic; CT of the cervical spine showed healing of the bony lesions. The halo vest was removed and physical therapy was recommended. Antituberculous treatment was continued for a total of 18 months, without any evidence of infection recurrence

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Communication Problems in Multiple Sclerosis: 9-Year Follow-Up

International Journal of MS Care ◽

10.7224/1537-2073-8.4.130 ◽

2006 ◽

Vol 8 (4) ◽

pp. 130-140 ◽

Cited By ~ 10

Author(s):

Per-Anders Bringfelt ◽

Lena Hartelius ◽

Björn Runmarker

Keyword(s):

Multiple Sclerosis ◽

Interpersonal Relationships ◽

Speech Intelligibility ◽

Speech Rate ◽

Neurological Deficits ◽

Communication Problems ◽

Age Related ◽

Communication Difficulties ◽

History Of

The speech of 18 individuals with a long history of multiple sclerosis (MS), assessed 9–10 years earlier, was reinvestigated. The individuals were also interviewed about their experiences of living with MS and how they have handled communication problems and symptoms in general. Findings were related to the degree of neurological deficit. The results showed that neurological deficits increased and certain speech parameters (sustained vowel phonation and speech rate) decreased significantly during this period. Speech intelligibility was not significantly changed (>90% at follow-up). Consequently, speech problems were generally mild. Nevertheless, analysis of the interviews showed that participation in communication and interpersonal relationships was affected by other disease-related (mobility, vision, cognition, and fatigue) and age-related problems. Strategies to reduce the effect of communication and disease-related problems were found to be active rather than adjustment or avoidance, both in specific situations and as an approach to life. In conclusion, the importance of a broader perspective on communication difficulties and a more individual approach to intervention should be emphasized, taking the patient's perceived barriers and self-generated strategies into account.

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Application of the 2010 McDonald criteria for the diagnosis of multiple sclerosis in a Spanish cohort of patients with clinically isolated syndromes

Multiple Sclerosis Journal ◽

10.1177/1352458511417828 ◽

2011 ◽

Vol 18 (1) ◽

pp. 39-44 ◽

Cited By ~ 27

Author(s):

M Gómez-Moreno ◽

M Díaz-Sánchez ◽

A Ramos-González

Keyword(s):

Multiple Sclerosis ◽

Mri Scan ◽

Clinically Isolated Syndromes ◽

Mcdonald Criteria ◽

International Panel ◽

Clinical Onset ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity ◽

New Criteria

Background: Recently the International Panel on Diagnosis of Multiple Sclerosis (MS) has proposed new magnetic resonance imaging (MRI) criteria for the diagnosis of MS in patients with clinically isolated syndromes (CIS). We aimed to evaluate the accuracy of these new criteria for lesions dissemination in space (DIS) and time (DIT), from a single MRI scan, to predict conversion from CIS to clinically definite MS. Methods: We studied 67 CIS patients with baseline MRI performed within the first 3 months after onset. The follow-up was of at least 24 months. The sensitivity, specificity and accuracy of Barkhof–Tintoré criteria and the new proposed MRI criteria for DIS and DIT were calculated with SPSS v.15.0. Results: The mean age for clinical onset was 30 years and 64% of patients were female. The overall conversion rate was 74%. In our cohort, Barkhof–Tintoré criteria showed a sensitivity of 71.43%, a specificity of 66.67%, with an accuracy of 73.1%. New DIS criteria showed a sensitivity of 85.71%, a specificity of 64.71% and an accuracy of 80.30%. We also evaluated the new DIT criteria with a single MRI scan in 54 patients with baseline scans that included gadolinium-enhanced images. The sensitivity of the test was 52.63% with a specificity of 75.00% and an accuracy of 59.26%. Conclusion: New DIS criteria are simpler and more sensitive than previous criteria. The sensitivity of DIT criterion using a single MRI scan was rather low, as other previous studies showed, reflecting its stringency, but it could improve the accuracy of early MS diagnosis in that group of patients with typical CIS and gadolinium-enhancing and non-enhancing lesions on their baseline scans. These results reinforce their use in MS diagnosis.

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Hematopoietic Islands Mimicking Osteoblastic Metastases in Axial Skeleton

10.21203/rs.3.rs-927101/v1 ◽

2021 ◽

Author(s):

Sophia Samira Goller ◽

Bernd Erber ◽

Nicola Fink ◽

Hans Roland Dürr ◽

Thomas Knösel ◽

...

Keyword(s):

Correct Diagnosis ◽

Axial Skeleton ◽

Appendicular Skeleton ◽

Imaging Findings ◽

Ct Guided ◽

Additional Information ◽

Ct Guided Biopsy ◽

Characteristic Imaging ◽

Important Additional Information

Abstract Background. Hyperplasia of the hematopoietic bone marrow in the appendicular skeleton is common. Focal hematopoietic islands within the axial skeleton is a rare entity and can cause confusion with osteoblastic metastases. The purpose of this study was to describe the characteristic imaging findings in MRI and CT.Methods. We retrospectively analyzed the imaging findings of 14 hematopoietic islands of the axial skeleton in ten patients (nine females, median age= 65.5 years [range, 49-74]), who received both CT and MRI at the time of initial diagnosis between 2006 and 2020. In five cases CT-guided biopsy was performed to confirm the diagnosis, while the other five patients received long term MRI follow-up (median follow-up= 28 months [range, 6-96 months]). Diffusion-weighted imaging was available in three, chemical shift imaging in two, 18F fluorodeoxyglucose PET/CT in two and Technetium 99m skeletal scintigraphy in one of the patients.Results. All lesions were small (mean size=1.72 cm2) and showed moderate hypointense signals on T1- and T2-weighted MRI sequences. They appeared iso- to slightly hyperintense on STIR images and showed slight enhancement after gadolinium administration. To differentiate this entity from osteoblastic metastases, CT provides important additional information, as hematopoietic islands do not show sclerosis. Conclusions. Hematopoietic islands within the axial skeleton can occur and mimic osteoblastic metastases. However, the combination of MRI and CT allows for making the correct diagnosis.

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