Spinal pain revealing brucellar spondylodiscitis: a case report

Abstract Background Brucellosis is an anthropozoonosis. It is an endemic disease in the Mediterranean basin. The clinical presentation is polymorphic. The osteoarticular form is the most frequent of the focal forms affecting mainly the spine. In our endemic context, the diagnosis can lead to confusion with tuberculosis. Case presentation We report a case of brucellar spondylodiscitis treated initially as tubercular spondylodiscitis with a good initial evolution. Then, the diagnosis was rectified towards a Brucella origin, after a clinical and biological relapse. Diagnostic confirmation was based on the isolation of Brucella spp in the disco-vertebral CT-guided biopsy and the positive Brucella serology. Then, the patient was put on three antibacterial treatments with doxycycline, rifampicin, plus streptomycin over a period of 6 months with a good evolution. Conclusion Brucellar spondylodiscitis is still common in the Maghreb. It is generally insidious and leads to a delay in diagnosis. The clinician must always mention it when faced with spondylodiscitis in an endemic country and ask for brucella serology.

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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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POS1283 SPONDILODISCITIS WITHOUT DOCUMENTED GERM: WHAT THERAPEUTIC MANAGEMENT?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3649 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 924.2-924

Author(s):

R. Grassa ◽

N. El Amri ◽

K. Baccouche ◽

S. Lataoui ◽

H. Zeglaoui ◽

...

Keyword(s):

Cutaneous Lesion ◽

Spinal Pain ◽

Neurological Complications ◽

Review Of The Literature ◽

Ct Guided ◽

Soft Tissue Extension ◽

Multi Stage ◽

Adjacent Structures ◽

Ct Guided Biopsy ◽

The Mean

Background:Spondylodiscitis (SD) is an infectious inflammation that affects the vertebrae, vertebral discs and adjacent structures. It may have a bacterial or non-bacterial etiology. Although analysis has improved and identification of pathogens is highly pursued, in one third of cases, no organism can be identified.Objectives:The objective of our work is to describe the epidemiological, clinical and evolutionary profile of SD with no germ identified and management.Methods:This is a retrospective study including 37 cases of SD with no germ identified, collected in the Rheumatology Department of Farhat Hached hospital in Sousse, Tunisia over a period of 22 years (1998-2020).Results:The mean age was 59.7 years [18-97 years]. These were 21 men (56.76 %) and 16 women (43.24 %).Spinal pain was the major symptom. The lumbar location was the most frequent in 56.76% of cases. It was a multifocal localization in 21.62%. The imaging allowed the detection of para abscesses -vertebral in 43.24%. An epiduritis was objectified in 54.05%.CT-guided biopsy was performed in 59.46% and it was not conclusive. A bacteriological survey was carried out and came back negative. Spondylodiscitis was presumed to be tubercular and staphylococcal in respectively 62.16 % and 18.92 %. The tuberculosis origin was retained in view of the chronic evolution, the multi-stage damage in the radiological assessment. While staphylococcal SD was retained due to the presence of cutaneous lesion and subacute evolution. Large-spectrum antibiotic therapy was initiated in the other cases.One case was initially considered to be staphylococcal but with epidural and soft tissue extension tuberculosis was then considered to be the cause. The evolution after initiation of adequate antibiotic treatment was interspersed with neurological complications in one case of tuberculosis SD.Conclusion:Our results show a higher frequency of presumed tuberculosis SD considering the endemicity of our country and the improvement under anti tuberculosis treatment.References:[1]Cornett, C. A., and al. Bacterial Spine Infections in Adults. Journal of the American Academy of Orthopaedic Surgeons, 24(1), 11–18.(2016)[2]Lener, S., and al Management of spinal infection: a review of the literature. Acta Neurochirurgica, 160(3), 487–496.(2018)[3]Homagk, L., and al SponDT (Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system. Journal of Orthopaedic Surgery and Research, 14(1).(2019)Disclosure of Interests:None declared

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Hip pain in children dilemmas in diagnosis and management a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203472 ◽

2020 ◽

Vol 8 (8) ◽

pp. 3098

Author(s):

Lakshmipriya Baskaran ◽

Ashok Thudukuchi Ramanathan

Keyword(s):

Clinical Presentation ◽

Chronic Osteomyelitis ◽

Final Diagnosis ◽

Blood Parameters ◽

Hip Pain ◽

Lytic Lesion ◽

Benign Bone Tumor ◽

Radiological Imaging ◽

Ct Guided ◽

Ct Guided Biopsy

Atraumatic hip pain in growing children is of varied etiology from developmental to infection and tumor. Differential clinical presentation of symptoms and investigation modalities like blood parameters and radiological imaging remains inconclusive at times with differential diagnosis. Biopsy remains the final say in conclusive of establishing final diagnosis unless proved otherwise. Bony lytic lesion of proximal femur in children without systemic illness mimicking benign bone tumor initially (osteiod osteoma) turned out to be chronic osteomyelitis on histopathologically following CT guided biopsy of the lesion which alters the course of management.

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Case Report of RANBP2 Mutation and Familial Acute Necrotizing Encephalopathy

International Journal of Pediatrics ◽

10.1155/2021/6695119 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Mohamad Paktinat ◽

Kamran Hessami ◽

Soroor Inaloo ◽

Hamid Nemati ◽

Pegah Katibeh ◽

...

Keyword(s):

Clinical Presentation ◽

Late Presentation ◽

Resonance Imaging ◽

Case Presentation ◽

Delay In Diagnosis ◽

Acute Necrotizing Encephalopathy ◽

High Clinical Suspicion ◽

Level Of Consciousness ◽

Acute Necrotizing ◽

Magnetic Resonance Imaging Mri

Introduction. Acute necrotizing encephalopathy (ANE), a rare entity with unique clinical presentation, can be associated significant morbidity and mortality. The majority of ANE reported cases are sporadic. However, reports of extremely rare familial cases are scarce. Case Presentation. We described three cases, two siblings and their cousin, affected by ANE, all of them exhibiting RAN-binding protein 2 (RANBP2) gene mutation. They all presented with seizure and decreased level of consciousness. Unlike the siblings, the cousin eventually expired mainly due to the delay in diagnosis, resulting from late presentation of typical brain involvements of ANE in magnetic resonance imaging (MRI). Conclusion. The presented cases are the first reports of familial ANE in Iran. Attempt was made to raise awareness on this disease, because high clinical suspicion plays an important role in the early diagnosis and proper management of these patients.

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AB0942 INFECTIOUS SPONDYLODISCITIS: TUBERCULOSIS VERSUS BRUCELLOSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4872 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1770.1-1770

Author(s):

R. Grassa ◽

J. Anoun ◽

M. Thabet ◽

D. E. H. Abid ◽

F. Ben Fredj ◽

...

Keyword(s):

Group Versus ◽

Spinal Pain ◽

Neurological Complications ◽

Ct Guided ◽

Medicine Department ◽

Ct Guided Biopsy ◽

Infectious Spondylodiscitis ◽

Vertebral Biopsy ◽

Inflammatory Syndrome

Background:Infectious spondylodiscitis is a serious impairment that can compromise the functional and vital prognosis. The determination of the germ responsible is the key of the treatment.Objectives:The objective of our work is to describe the epidemiological, clinical and evolutionary profile according to the germ responsible by comparing tuberculous and brucellar spondylodiscitis.Methods:This is a retrospective study including 32 cases of spondylodiscitis with specific germs (Mycobacterium tuberculosis and Brucella) collected in an internal medicine department over a period of 18 years (2000-2018).Results:These were 20 men and 12 women with an M / F ratio of 1.66. The average age of our patients was 50.63 [16-84]. The germ implicated was Koch’s Bacillus in 11 patients (34.38%) and Brucella in 21 patients (65.63%). The mean age for tuberculosis (TB) was 45.18 years versus 53.48 years for brucellosis. Spinal pain was the major symptom in the 02 groups. The deterioration in general condition was present in 80.95% for the brucellosis group versus 81.82% for the tuberculosis group.Biological inflammatory syndrome was observed in 94.24% of the brucellosis group and 63.63% of the TBC group. The lumbar location was the most frequent in the 02 groups (71.88%).It was a multifocal localization in 27.27% (TB) and 61.90% (Brucellosis) respectively. The imaging allowed the detection of para abscesses -vertebral in 54.55% for the TB group versus 23.81% for the brucellar group. An epiduritis was objectified in 36.36% of the TB group against 33.33% for that of brucellar. CT-guided biopsy was performed in 54.55% of tuberculosis patients compared to 47.62% in the other group. It was only positive in one case of brucellosis, whereas it allowed diagnosis in 36.36% of cases of TB.The evolution after initiation of adequate antibiotic treatment was interspersed with neurological complications in the tuberculosis group in 18.18% of cases against 14.29% in the brucellosis group. Draining abscess was necessary in the tuberculosis group in 18.18% and in 9.52% of the brucellosis cases.Conclusion:Our results show a higher frequency of neurological complications in tuberculosis forms. Vertebral biopsy is of no interest in Brucellar spondylodiscitis unlike tuberculosis forms where it allows the diagnosis.References:[1]Bousson,et al (2014). Infection rachidienne: du germe lent au staphylocoque doré. Revue Du Rhumatisme Monographies, 81(1), 27–35.[2]Bierry, G., & Dietemann, J.-L. (2012). Imagerie des spondylodiscites infectieuses. EMC - Radiologie et Imagerie Médicale - Musculosquelettique - Neurologique - Maxillofaciale, 7(4), 1–16.Disclosure of Interests:None declared

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Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

Iranian Journal of Neurosurgery ◽

10.32598/irjns.5.3.9 ◽

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.

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