scholarly journals Disseminated Mycobacterium chimaera Presenting as Vertebral Osteomyelitis

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Daphne M. Moutsoglou ◽  
Frank Merritt ◽  
Ethan Cumbler
Keyword(s):  
Weight Loss ◽  
Cardiac Surgery ◽  
Elderly Woman ◽  
Chronic Back Pain ◽  
Vertebral Osteomyelitis ◽  
Nontuberculous Mycobacterium ◽  
Low Grade ◽  
History Of ◽  
Soft Tissue Abscess ◽  
Slow Growing

Mycobacterium chimaera, a member of the Mycobacterium avium complex, is a slow-growing, nontuberculous mycobacterium associated with outbreaks in cardiac-surgery patients supported on heart-lung machines. We report a case of an elderly woman on chronic prednisone who presented with a six-month history of worsening chronic back pain, recurrent low-grade fevers, and weight loss. Imaging identified multilevel vertebral osteomyelitis and lumbar soft-tissue abscess. Abscess culture identified M. chimaera.

scholarly journals P045 Nothing is too 'cagey' for the rheumatologist

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Muhammad F Kazmi
Keyword(s):  
Weight Loss ◽  
Inflammatory Markers ◽  
Low Grade ◽  
Careful Monitoring ◽  
Chronic Infections ◽  
Asian Origin ◽  
Travel History ◽  
Chest Clinic ◽  
History Of ◽  
Inflammatory Changes

Abstract Background/Aims  Rheumatological conditions can present with a number of non-specific features like arthralgia, fever, fatigue, weight loss along with raised inflammatory markers and positive antibodies. Due to this, when similar symptoms are referred for input it is very important to consider other ‘mimics’. We report a case of Pigeon fancier’s lung presenting with these symptoms which was referred as likely connective tissue disease. Methods  A 52-year-old lady of South Asian origin was referred by her GP with six month history of 3kg weight loss, arthralgia, fatigue, low grade fever and persistently raised inflammatory markers (ESR ranging from 50-64 mm/hr, CRP 10-14 mg/L, normal BMI). On further questioning there was history of mouth ulcers, non-specific rash, occasional cough but no Raynaud’s or joint swelling. Blood investigations showed weakly positive ANA and RF but negative ENA, DNA, antiCCP , CK, C3,C4. C-ANCA was positive but PR3 negative. CXR was clear and tests for chronic infections including TB were negative. Due to lack of objective CTD signs, plan was to take a careful monitoring approach to see if clinical features evolved. A month later due to worsening cough, a CT chest/abdomen arranged by GP showed ground-glass changes consistent with pneumonitis and hence her rheumatology appointment was expedited to see if there was an autoimmune unifying diagnosis. She was also referred by her GP to the chest clinic in view of CT report and mild shortness of breath. Results  On further review, again there were no objective CTD signs. On direct questioning there was history of travelling before worsening chest symptoms to South Asia. Also around a year before her symptoms started she was given an African grey parrot. Based on this, serology for Avian precipitin was checked which showed strongly positive IgG antibodies to avian antigens (Budgerigar droppings and feathers, Pigeon feathers IgG Abs) confirming the diagnosis of pigeon fanciers lung. She fulfilled the diagnostic criteria and was asked to avoid the trigger. Urgent respiratory input was arranged where diagnosis was agreed with and disease was deemed sub-acute in presentation. Due to PFTs showing low transfer factor of 38%, Prednisolone was started with significant improvement within few days. Review of CT chest only showed inflammatory changes and no established fibrosis predicting excellent prognosis as delay in treatment can cause irreversible pulmonary fibrosis. Conclusion  A number of conditions can mimic rheumatological conditions which usually turn out to be either infectious or malignant in origin. This case highlights the importance of considering other differentials and along with taking a travel history also asking for other possible triggers like pets. In similar scenarios the diagnosis may be ‘cagey’ but as rheumatologists we are expected to answers questions which others can’t. Disclosure  M.F. Kazmi: None.

Diagnosing Bird Fancier's Disease in Children

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 848-852
Author(s):  
WILLIAM F. H. YEE ◽  
ROBERT G. CASTILE ◽  
AMIEL COOPER ◽  
MARY ROBERTS ◽  
ROY PATTERSON
Keyword(s):  
Weight Loss ◽  
Environmental History ◽  
Respiratory Symptoms ◽  
Hypersensitivity Pneumonitis ◽  
Case Reports ◽  
Low Grade ◽  
Poor Appetite ◽  
The Family ◽  
History Of ◽  
Respiratory Complaints

Bird fancier's disease is a form of hypersensitivity pneumonitis resulting from inhalation of various avian proteins. It is rarely diagnosed in childhood but should be considered in any child with persistent unexplained respiratory symptoms.1,2 We describe two patients referred to our pulmonary clinic with nonspecific respiratory complaints, in whom the diagnosis of avian protein-related hypersensitivity pneumonitis was initially not confirmed by serologic studies. CASE REPORTS Patient 1 An 11-year-old boy was admitted to the hospital with a 1-year history of a mild nonproductive cough, poor appetite, weight loss, malaise, and an intermittent low-grade fever. According to an environmental history, the boy's father had been breeding pigeons, canaries, and parakeets in the family yard for years.

Clinico-demographic Characteristics of Patients with Cirrhosis of Liver : Experienced at a Tertiary Care Hospital

2013 ◽  
Vol 20 (Number 1) ◽  
pp. 8-14
Author(s):  
AKM S Kabir ◽  
Md. F Alam ◽  
C K Ghosh ◽  
S N Ahmed ◽  
S Sikder
Keyword(s):  
Weight Loss ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Demographic Characteristics ◽  
Global Perspective ◽  
Low Grade ◽  
Care Hospital ◽  
Female Ratio ◽  
History Of ◽  
Cirrhosis Of Liver

Cirrhosis of liver is one of the commonest hepatobiliary problems in Bangladesh as well as in global perspective. The purpose of the present study was to find out the clinico-demographic characteristics of liver cirrhosis patients admitted at a tertiary care hospital. Patients who are clinically suspected to have cirrhosis of liver, admitted in medicine units of Holy Family Red Crescent Medical College Hospital, Dhaka have been analyzed regarding clinical presentation and complications profile. Total 100 patients were included of which 84% were cirrhosis of liver, 7% were chronic active hepatitis, 3% were chronic persistent hepatitis, 2% were Wilson's disease with cirrhosis and 4% were hepatocellular carcinoma (HCC) on the top of cirrhosis of liver. The peak age incidence was between 31-50 years with male-female ratio of 4.88:1. History of jaundice (42%), parenteral medications (14%), infusion (6%) and abdominal surgery (4.0%) were important findings from patient's past history. History of alcohol intake was found in only 4% cases. Overall, weakness (78%), anorexia (72%), abdominal swelling (74%), weight loss (64%), ankle swelling (42%), low grade fever (35%) and yellowish discolouration of eyes, skin and urine (37%) were the most common symptoms. Common signs, revealed by clinical examination as a whole, were anaemia (55%), ascites (68%), oedema (52%), jaundice (34%), palpable spleen (55%) and hepatic facies (37%). Cirrhosis of liver most commonly occurs in middle aged male patients. Weakness, weight loss, anorexia, abdominal discomfort/dyspepsia and swelling of the abdomen are the most prevalent symptoms.

scholarly journals OUTCOME OF STRICTUROPLASTY IN PATIENTS WITH INTESTINAL TUBERCULOSIS

2012 ◽  
Vol 19 (03) ◽  
pp. 411-417
Author(s):  
G. M. KHAN BALOCH ◽  
KHALID HUSSAIN QURESHI ◽  
ASIM BHATTI
Keyword(s):  
Weight Loss ◽  
Past History ◽  
Intestinal Tuberculosis ◽  
Case Series ◽  
Wound Dehiscence ◽  
Low Grade ◽  
Pain Abdomen ◽  
History Of ◽  
Extra Pulmonary ◽  
Easy Operation

Introduction: Abdominal TB is one of the most prevalent forms of extra-pulmonary disease and is prevalent all over the world.Gastrointestinal involvement had been reported to be 55-90%. This study aimed to determine the outcome of stricturoplasty in patients withintestinal tuberculosis. Objective: To determine the outcome of stricturoplasty in patients with intestinal tuberculosis. Study Design:Descriptive case series. Setting: Department of General Surgery, Nishtar Hospital Multan. Duration with dates: Three years from January2009 to December 2011. Subjects & Methods: 120 patients of intestinal TB, who presented with intestinal obstruction in emergency and withsigns and symptoms of intestinal TB in outdoor patient department were selected. History of contact, family history of tuberculosis,immunization, past history of tuberculosis was taken. Diagnosis was confirmed by histopathology. Laparatomy was done in all cases andstricturoplasty was performed. Patients were followed up during hospitalization. Postoperative complications were noted. All information wererecorded on a proforma. Results: Out of 120 patients, 56.7% were male and 43.3% were female having age between 14 to 70 years. Mainpresenting symptoms were pain abdomen, vomiting, distension of abdomen, weight loss, anorexia and low grade fever with sweats. Maincomplications after stricturoplasty were chest infection 40(33.3%), wound dehiscence in 16(13.3%), leakage in 12(10%), recurrence in20(16.7%), scar pigmentation in 12(10%), keloid in 12(10%) patients and herniation in 8(6.7%) patients. Conclusions: Stricturoplasty is a safe,simple and easy operation, particularly useful at small peripheral hospitals with limited staff and resources.

scholarly journals Unusual Case of Osteomyelitis and Discitis in a Drug User with a Background of Chronic Back Pain: Do Not Miss the Serious Etiologies

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Alaa M. Ali ◽  
Moona Khan ◽  
Shawn G. Kwatra ◽  
Aram Barbaryan ◽  
Nasir Hussain ◽  
...  
Keyword(s):  
Back Pain ◽  
Unusual Case ◽  
Chronic Back Pain ◽  
Vertebral Osteomyelitis ◽  
Past Medical History ◽  
Iv Drug Abuse ◽  
Occult Malignancy ◽  
Acute Back Pain ◽  
History Of ◽  
Significant Probability

Chronic back pain is a common presenting complaint that is frequently encountered by clinicians. The challenge for clinicians is identifying the relatively few patients with a significant probability of a more serious problem that requires further evaluation. Such individuals require further evaluation for possible occult malignancy, infection, or fracture. We present a case of a 50-year-old male with a past medical history of chronic back pain and IV drug abuse who presented with acute back pain and in whom a diagnosis of vertebral osteomyelitis was missed during multiple visits to the emergency room.

scholarly journals PRIMARY DIAPHYSEAL TUBERCULOUS OSTEOMYELITIS OF TIBIA

2014 ◽  
Vol 21 (06) ◽  
pp. 1282-1284
Author(s):  
Ghulam Mustafa Kaim Khan ◽  
Syed Mujahid Humail ◽  
Kamran Hafeez
Keyword(s):  
Weight Loss ◽  
Developing Countries ◽  
Differential Diagnosis ◽  
Osteolytic Lesion ◽  
Long Bone ◽  
Low Grade ◽  
X Rays ◽  
X Ray ◽  
Tuberculous Osteomyelitis ◽  
History Of

Diaphyseal tubercular osteomyelitis of long bone is extremely rare and few cases have been reported in literature. We are presenting a case of 17 years old girl presented with pain and swelling over lower half of leg for 7 months. There was often low grade fever but no history of weight loss or pulmonary symptoms. X-ray chest was normal. X-rays and MRI of involved leg were suggestive of osteomyelitis. Curettage and biopsy was done, report was suggestive of tuberculous osteomyelitis. As tuberculosis is still common in developing countries, for an osteolytic lesion in bone, tuberculous osteomyelitis should be considered in differential diagnosis.

scholarly journals Tubercular Osteomyelitis of Tibia: A Case Report

2019 ◽  
Vol 2 (1) ◽  
pp. 92-94
Author(s):  
Amin Kumar Shrestha ◽  
Suman Raja Shrestha ◽  
Gopesh Kumar Thakur ◽  
Arjun Prasad Dumre
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Osteolytic Lesion ◽  
Extrapulmonary Tuberculosis ◽  
Long Bone ◽  
Low Grade ◽  
X Rays ◽  
X Ray ◽  
Tuberculous Osteomyelitis ◽  
History Of

Tubercular osteomyelitis of long bone is extremely rare and very few cases have been reported in literature. We are presenting a case of 43 years gentlemen presented with pain and swelling over lower half of leg for 5 months. There was associated pus discharging sinus and often low-grade fever but no history of weight loss or pulmonary symptoms. X-ray chest was normal. X-rays of involved leg was suggestive of osteomyelitis. Curettage and Biopsy was done, report was suggestive of tuberculous osteomyelitis. As tuberculosis is still common in developing countries like Nepal, for any osteolytic lesion in bone, tubercular osteomyelitis should always be considered in differential diagnosis. Keywords: extrapulmonary tuberculosis; osteolytic lesion in bone; tubercular osteomyelitis.

scholarly journals Rare case of a liposarcoma in the brachial plexus

2016 ◽  
Vol 98 (7) ◽  
pp. e106-e108 ◽  
Author(s):  
D Kosutic ◽  
K Gajanan
Keyword(s):  
Brachial Plexus ◽  
Low Grade ◽  
Connective Tissues ◽  
Adequate Treatment ◽  
Long Term Follow Up ◽  
History Of ◽  
Axillary Mass ◽  
Painless Mass ◽  
The Right ◽  
Slow Growing

Introduction A liposarcoma is a rare cancer of connective tissues that resemble fat cells under light microscopy. Case History A 73-year old female patient presented to our tertiary cancer centre with an eight-year history of a large, slow-growing painless mass in the right axilla. Magnetic resonance imaging showed a lipomatous, well-circumscribed mass of dimension 30 × 16 × 10cm extending towards the right clavicle and causing deformation to the right chest wall and right breast. Surgery revealed a large tumour that had stretched all three cords of the brachial plexus. Histopathology was consistent with a diagnosis of a low-grade liposarcoma. After a period of neuropraxia, the patient returned to normal activities 4 months after surgery. Conclusions Although extremely rare, low-grade liposarcomas of the brachial plexus should be considered in the differential diagnosis of a slow-growing axillary mass. Referral to a tertiary sarcoma centre is essential for an appropriate diagnosis, adequate treatment, and long-term follow-up.

Primary acquired melanosis (PAM) without atypia/WHO low-grade conjunctival melanocytic intraepithelial lesion over areas of oculodermal melanocytosis

2020 ◽  
Vol 13 (10) ◽  
pp. e236741
Author(s):  
Bashar M Bata ◽  
Sachin M Salvi ◽  
Hardeep Singh Mudhar
Keyword(s):  
Bulbar Conjunctiva ◽  
Low Grade ◽  
Primary Acquired Melanosis ◽  
Conjunctival Biopsy ◽  
History Of ◽  
Intraepithelial Lesion ◽  
The Relationship ◽  
Oculodermal Melanocytosis ◽  
Substantia Propria ◽  
New Onset

An elderly white man with a history of left oculodermal melanocytosis presented with new onset brown pigmentation of the left bulbar and inferior tarsal conjunctiva. The bulbar conjunctival pigmentation was at the level of the conjunctival epithelium and was overlying areas of typical slate-grey scleral pigmentation characteristic of oculodermal melanocytosis. Both areas of new pigmentation were biopsied. The bulbar conjunctiva revealed primary acquired melanosis (PAM) without atypia with increased melanin production and the tarsal conjunctival biopsy showed PAM without atypia sine pigmentio overlying areas of substantia propria spindle-shaped heavily pigmented melanocytes of oculodermal melanocytosis. The case report examines the relationship between the epithelial and substantia propria melanocytes and correlates the findings with what is known about this association from the dermatopathology literature.

scholarly journals Fecal Metaproteomics Reveals Reduced Gut Inflammation and Changed Microbial Metabolism Following Lifestyle-Induced Weight Loss

Biomolecules ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 726
Author(s):  
Ronald Biemann ◽  
Enrico Buß ◽  
Dirk Benndorf ◽  
Theresa Lehmann ◽  
Kay Schallert ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Weight Loss ◽  
Gut Microbiome ◽  
Taxonomic Composition ◽  
Low Grade ◽  
Gut Inflammation ◽  
Functional Changes ◽  
Microbiome Composition ◽  
Before And After ◽  
Human Proteins

Gut microbiota-mediated inflammation promotes obesity-associated low-grade inflammation, which represents a hallmark of metabolic syndrome. To investigate if lifestyle-induced weight loss (WL) may modulate the gut microbiome composition and its interaction with the host on a functional level, we analyzed the fecal metaproteome of 33 individuals with metabolic syndrome in a longitudinal study before and after lifestyle-induced WL in a well-defined cohort. The 6-month WL intervention resulted in reduced BMI (−13.7%), improved insulin sensitivity (HOMA-IR, −46.1%), and reduced levels of circulating hsCRP (−39.9%), indicating metabolic syndrome reversal. The metaprotein spectra revealed a decrease of human proteins associated with gut inflammation. Taxonomic analysis revealed only minor changes in the bacterial composition with an increase of the families Desulfovibrionaceae, Leptospiraceae, Syntrophomonadaceae, Thermotogaceae and Verrucomicrobiaceae. Yet we detected an increased abundance of microbial metaprotein spectra that suggest an enhanced hydrolysis of complex carbohydrates. Hence, lifestyle-induced WL was associated with reduced gut inflammation and functional changes of human and microbial enzymes for carbohydrate hydrolysis while the taxonomic composition of the gut microbiome remained almost stable. The metaproteomics workflow has proven to be a suitable method for monitoring inflammatory changes in the fecal metaproteome.

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