Recurrent ominous spinal mass

<p class="abstract">Hypertrophic pachymeningitis is a very rare form of diffuse inflammatory dural fibrosis. It is typically encountered intracranially rather than spinally and can have a progressive and recurrent course as encountered in our patient. The aetiology of this disorder is multifactorial. While acute management of hypertrophic pachymeningitis consists of immediate decompression in conjunction with steroid medication and treatment of the underlying disease, the management of chronic and recurrent disease is controversially debated in the current literature. A previously healthy 49-year-old woman presented with progressive back pain and acute onset of incomplete paraplegia. Spinal MRI showed a large ventral semicircular mass with intense contrast enhancement from Th3-8. Acute patient management consisted of immediate decompression and debulking the space-occupying lesion in conjunction with antibiotic and steroid therapy. Histopathologic examination of the surgical specimens revealed a chronic inflammatory process. The patient fortunately recovered from the severe paraparesis and upon discharged, spinal MRI disclosed a further regressing residual spinal mass. Over time, our patient suffered two times a relapse and was finally treated with Methotrexate and low-dose steroids. Under this medication she has made a nearly complete neurological recovery. This case report highlights a rare disease with challenging management, which should be considered diagnostically in patients with intraspinal space-occupying lesions. In our experience combination of Methotrexate and low-dose steroids might be an effective and safe treatment.</p>

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Hypertrophic pachymeningitis: case report

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2003000100021 ◽

2003 ◽

Vol 61 (1) ◽

pp. 107-111 ◽

Cited By ~ 10

Author(s):

Leonardo de Deus-Silva ◽

Luciano de Souza Queiroz ◽

Verônica de Araújo Zanardi ◽

Enrico Ghizoni ◽

Hoyama da Costa Pereira ◽

...

Keyword(s):

Case Report ◽

Optic Atrophy ◽

Nasal Septum ◽

Visual Loss ◽

Inflammatory Process ◽

Inflammatory Diseases ◽

Early Stage ◽

Underlying Disease ◽

Extensive Investigation ◽

Hypertrophic Pachymeningitis

Hypertrophic pachymeningits is an unusual cause of neurological symptoms and is often secondary to infections, carcinomatosis or inflammatory diseases. It may also be idiopathic. We report a case of pachymeningitis which was manifested primarily by psychosis and visual loss with optic atrophy and destruction of nasal septum. The patient, a 45 year old woman was submitted to extensive investigation without evidence of any underlying disease. A meningeal biopsy was performed and showed a mostly unspecific inflammatory process with extensive fibrosis of the dura and few early stage granulomas. These findings suggest either neurosarcoidosis or idiopathic hypertrophic pachymeningitis.

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P0045 : Long term low dose steroid triple immunosuppressive regimens in post transplant autoimmune hepatitis (AIH) patients reduces the incidence of recurrent disease and is not associated with increased mortality

Journal of Hepatology ◽

10.1016/s0168-8278(15)30251-8 ◽

2015 ◽

Vol 62 ◽

pp. S308-S309

Author(s):

T.L. Krishnamoorthy ◽

J. Miezynska-Kurtycz ◽

J. Hodson ◽

B.K. Gunson ◽

J. Neuberger ◽

...

Keyword(s):

Autoimmune Hepatitis ◽

Low Dose ◽

Recurrent Disease ◽

Post Transplant

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Carboplatin plus Taxol is an Effective Third-line Regimen in Recurrent Undifferentiated Nasopharyngeal Carcinoma

Tumori Journal ◽

10.1177/030089160208800405 ◽

2002 ◽

Vol 88 (4) ◽

pp. 273-276 ◽

Cited By ~ 21

Author(s):

Mario Airoldi ◽

Fulvia Pedani ◽

Sara Marchionatti ◽

Anna Maria Gabriele ◽

Giovanni Succo ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Median Overall Survival ◽

Low Dose ◽

Recurrent Disease ◽

Nasopharyngeal Cancer ◽

First Line ◽

Second Line Therapy ◽

Previously Treated ◽

Third Line ◽

Undifferentiated Nasopharyngeal Carcinoma

Background Recurrent undifferentiated nasopharyngeal carcinoma is a chemosensitive disease. Few third-line treatments have been reported. Methods Twelve patients (9 males, 3 females; median age 50 years, range, 20-62) with recurrent undifferentiated nasopharyngeal carcinoma were treated with carboplatin AUC 5.5 + paclitaxel (175 mg/m2, 3-hr infusion) on day 1 every 3 weeks. All patients had been previously treated for recurrent disease with a first-line cisplatin-based chemotherapy and a second-line therapy with low-dose continous infusion 5-fluorouracil. Results Overall, 54 courses were given (median, 5; range, 2-6). Three patients (25%) obtained a partial response lasting 6, 10 and 26+ months, 1 (8.3%) a minimal response lasting 6 months, and 3 (25%) no change with a median duration of 5 months. The median survival time was 14 months for patients who had a partial or minimal response or no change, and 5 months for nonresponders. Median overall survival was 9.5 months (3-30+). The treatment was well tolerated, and toxicity was manageable. Conclusions The combination has a good pallitive role as third-line chemotherapy in recurrent undifferentiated nasopharyngeal cancer.

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Orbital and Periorbital Cellulitis

Pediatrics in Review ◽

10.1542/pir.16.5.163 ◽

1995 ◽

Vol 16 (5) ◽

pp. 163-167

Author(s):

Keith R. Powell

Keyword(s):

Inflammatory Process ◽

Subcutaneous Tissue ◽

Acute Onset ◽

Orbital Cellulitis ◽

The Body ◽

Vein Thrombosis ◽

Orbital Septum ◽

Specific Complication ◽

Thin Skin ◽

Doctor's Office

The acute onset of eyelid redness and swelling in a child usually results in a quick visit to the doctor's office or an emergency room. The differential diagnosis for these signs ranges from relatively innocuous problems, such as allergy or an insect sting, to potentially vision-affecting or even life-threatening diseases, such as orbital cellulitis or cavernous vein thrombosis. The orbital contents often are protected from an inflammatory process by the orbital septum, a continuation of the periosteum of the bony orbit to the margins of both the upper and lower eyelids (Figure 1). An inflammatory process occurring in the structures superficial to the orbital septum is defined as preseptal or periorbital cellulitis; an inflammatory process in structures deep to the orbital septum is defined as orbital cellulitis of a specific complication thereof. Bacterial infection can cause both periorbital and orbital cellulitis. Another anatomic feature of importance is that the skin of the eyelid is the thinnest skin of the body. The subcutaneous tissue of the eyelid is composed of musculofibrous tissue and no fat. This combination of thin skin and loose subcutaneous tissues makes it possible for the eyelid to swell dramatically as it fills with edematous fluid. Epidemiology and Pathogenesis of Periorbital Cellulitis

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SOME ASPECTS OF CT ASSESSMENT OF SUPRAVESICAL URINARY TRACT IN PATIENTS AFTER CYSTILEOPLASTICS

Clinical Practice ◽

10.17816/clinpract2154-56 ◽

2011 ◽

Vol 2 (1) ◽

pp. 54-56

Author(s):

O P Sukhanova ◽

T S Borondzhiyan ◽

E V Minasyan

Keyword(s):

Urinary Tract ◽

Radical Cystectomy ◽

Postoperative Period ◽

Inflammatory Process ◽

Underlying Disease ◽

The State ◽

Malignant Lesions ◽

Degrees Of Severity ◽

Late Postoperative Period ◽

Ct Studies

The purpose of the research was to determine morphological and urodynamic changes of supravesical urinary tract in patients after cystileoplastics. Methods. CT studies in the late postoperative period in 19 patients after radical cystectomy, combined with vesiculoprostatectomy and cystoileoplastics and malignant lesions of the bladder were performed. Results. None of cases revealed signs of continued growth. In 57% of the cases it was evidence of lymphadenopathy in the absence of negative dynamics of the underlying disease. No dependence of the state of anastomoses of the volume formed by the reservoir and the degree of shortening of the ureter was found. In assessing the state of supravesical urinary tract 11 from 19 (57,8%) patients were registered varying degrees of severity gidroureteronephrosis, and in 4 patients, pelvic ureteric reflux. All patients with urodynamic disorders identified "new bladder" had less volume than patients who did not have these disorders. Conclusion. CT study is the method of choice in the evaluation of supravesical urinary tract after cystoileoplastics for timely prevention of complications of an inflammatory process. It was revealed that the degree of changes in the urinary tract depending of the volume of the reservoir formed, requires further analysis.

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Shingles: More than Meets the Eye

Folia Medica ◽

10.2478/folmed-2018-0046 ◽

2019 ◽

Vol 61 (1) ◽

pp. 158-162 ◽

Cited By ~ 1

Author(s):

Radka T. Komitova ◽

Vasko A Grklanov ◽

Konstantinos K. Lindas ◽

Petya V. Ganeva

Keyword(s):

Oral Mucositis ◽

Low Dose ◽

Correct Diagnosis ◽

Underlying Disease ◽

Patient Reporting ◽

First Line ◽

Good Safety Profile ◽

Subsequent Withdrawal ◽

Patient’S History ◽

Difficult Cases

Abstract Low-dose once weekly methotrexate (MTX) is the first-line disease-modifying antirheumatic drug (DMARD) to treat rheumatoid arthritis and psoriasis. Although methotrexate is generally considered to have a good safety profile it can occasionally induce severe side effects such as pancytopenia, mucositis, disorders of kidney and liver. Oral mucositis should alert physicians to MTX toxicity. We report a 64-year-old woman with a severe drug reaction including disseminated shingles, oral mucositis and pancytopenia only three days after starting a therapeutic low-dose of MTX. Initially, mucositis and myelosuppression couldn’t be accounted for by the underlying disease. In taking the patient’s history, MTX intake 10 days ago was missed, the patient reporting only current medications. However, there was more to the skin rash than meets the eye. Only after further inquiry did the patient reveal the intake of 2 doses of MTX and the subsequent withdrawal of medication. Arriving at the correct diagnosis in difficult cases, as in the case presented, requires further evaluation, including repeat history taking and eliciting more details if diagnosis remains elusive.

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CT and pathological features in renal parenchymal malakoplakia: a case report and review of the literature

Aktuelle Urologie ◽

10.1055/a-1300-5892 ◽

2021 ◽

Author(s):

Yuanfen Yang

Keyword(s):

Ct Scan ◽

Soft Tissue Mass ◽

Left Kidney ◽

Underlying Disease ◽

Pathological Features ◽

Rare Form ◽

Tissue Mass ◽

Enhanced Ct ◽

Immunocompromised Status ◽

Solid Part

AbstractRenal malakoplakia is a rare form of chronic inflammatory granulomatous disease in the kidney. It occurs in adult patients with immunocompromised status or debilitating disease. In the present study, we reported a case of a 50-year-old woman with no underlying disease. This report describes the CT and pathological features of renal malakoplakia in a 50-year-old woman. Plain CT scan showed a large soft tissue mass at the middle and upper pole of the left kidney. Enhanced CT scan showed delayed enhancement in the solid part of the mass. Our results might provide some useful information for the diagnosis of renal parenchymal malakoplakia.

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Suppurative Thrombophlebitis: Correlation Between Pathogen and Underlying Disease

Infection Control ◽

10.1017/s0195941700065425 ◽

1986 ◽

Vol 7 (12) ◽

pp. 582-585 ◽

Cited By ~ 14

Author(s):

Capt Robert A. Johnson ◽

Capt Robert A. Zajac ◽

Maj Martin E. Evans

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Nosocomial Infection ◽

Abdominal Surgery ◽

General Hospital ◽

Inflammatory Process ◽

Surgical Intervention ◽

Underlying Disease ◽

Streptococcus Faecalis ◽

Apparent Association

AbstractWe identified 29 episodes of suppurative thrombophlebitis in 27 patients admitted to a large general hospital between May 1980 and May 1984. In 25 patients, the intravenous cannulae had been in place for more than 3 days. Streptococcus faecalis, Pseudomonas aeruginosa or one of the Enterobacteriaceae were implicated in 14 patients. All these patients had recently undergone abdominal surgery or had a major intraabdominal inflammatory process at the time they developed thrombophlebitis. The remaining 13 patients were infected with Staphylococcus aureus, other grampositive cocci or Candida species. Only two of these had an active abdominal process at the time of their infection (x2 = 16.08, P<0.001). There is an apparent association between phlebitis caused by enteric organisms and active intra-abdominal pathology. There were two deaths related to delayed or deferred surgery. Suppurative thrombophlebitis is a lethal, preventable nosocomial infection that requires urgent surgical intervention.

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