(Pseudo)septische artritis na schoudervaccinatie

(Pseudo) septic arthritis after shoulder vaccination (Pseudo)septic arthritis after shoulder vaccination is a rare complication that urges rapid recognition and adequate treatment to minimize damage to the joint and even prevent a fatal ending. We describe a case concerning an 82-year-old woman who presented herself at the emergency department with acute, fast evolving right shoulder pain after the administration of an intramuscular pneumococcal vaccine (PPV23) 8 hours earlier. We performed a blood sample analysis, ultrasound of the shoulder joint and eventually an arthroscopy to finally confirm a diagnosis of a “septic arthritis after shoulder vaccination”. In this report the different mechanisms and complications of shoulder injury related to vaccine administration (SIRVA) are explained, alongside a description of the right treatment of a (pseudo)septic SIRVA as well as proposed measures to prevent this possibly fatal complication of an act that is an almost daily occupation for many medical doctors.

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Case Report of Traumatic Uterine Rupture in a Multigravida Woman with Emergency Department Cesarean Section

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.8.48388 ◽

2020 ◽

Vol 4 (4) ◽

pp. 623-625

Author(s):

Krista Wiese ◽

Stacey Ernest ◽

W. Seth Dukes

Keyword(s):

Emergency Department ◽

Case Report ◽

Cesarean Section ◽

Uterine Rupture ◽

Motor Vehicle ◽

Rare Complication ◽

Cesarean Sections ◽

Vehicle Collision ◽

Emergency Cesarean ◽

The Right

Introduction: Uterine ruptures in blunt trauma are an extremely rare complication. Furthermore, while perimortem cesarean sections in cardiac arrest patients are a well-established practice in emergency medicine, cesarean sections in the emergency department are rarely performed on non-arresting patients. Case Report: A multigravida woman at approximately 24 weeks gestation presented as a transfer from an outside hospital after a motor vehicle collision. Upon arriving to our facility, she underwent an emergency cesarean section in the trauma bay and was found to have a uterine rupture with the fetus free floating in the right upper quadrant of the abdomen. Conclusion: Uterine rupture is a rare but important complication of blunt abdominal trauma in pregnant patients. Resuscitative cesarean sections may be necessary for favorable outcomes. A well prepared and diversified team was essential to maternal survival.

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Hepatic brucelloma: a rare complication of a common zoonotic disease

BMJ Case Reports ◽

10.1136/bcr-2020-237076 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237076

Author(s):

George Vatidis ◽

Eirini I Rigopoulou ◽

Konstantinos Tepetes ◽

George N Dalekos

Keyword(s):

Rare Complication ◽

Surgical Excision ◽

Coombs Test ◽

Inflammation Markers ◽

Laboratory Findings ◽

Ct Guided ◽

Rare Manifestation ◽

Bone Marrow Cultures ◽

History Of ◽

The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

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Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19

BMJ Case Reports ◽

10.1136/bcr-2021-242370 ◽

2021 ◽

Vol 14 (4) ◽

pp. e242370

Author(s):

Jiodany Perez ◽

Stefani Sorensen ◽

Michael Rosselli

Keyword(s):

Emergency Department ◽

Septic Arthritis ◽

Glenohumeral Joint ◽

Imaging Modality ◽

Point Of Care ◽

Significant Morbidity ◽

Anchoring Bias ◽

Septic Bursitis ◽

Musculoskeletal Ultrasonography ◽

Point Of Care Ultrasonography

Prompt recognition and treatment of septic arthritis are crucial to prevent significant morbidity and mortality in affected patients. During the current COVID-19 pandemic, anchoring bias may make an already challenging diagnosis like septic arthritis more difficult to diagnose quickly and efficiently. Musculoskeletal (MSK) point of care ultrasonography (POCUS) is an imaging modality that can be used to quickly and efficiently obtain objective findings that may help a clinician establish the diagnosis of septic arthritis. We report a case where MSK POCUS was a key element in establishing the diagnosis of glenohumeral joint septic arthritis and subdeltoid septic bursitis for a patient that presented to the emergency department with a fever during the era of the COVID-19 pandemic.

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Acute otitis media in an infant complicated with osteoarthritis of temporomandibular joint and sub-periosteal abscess of the clavicle

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00123-8 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Kaoutar Cherrabi ◽

Hind Cherrabi

Keyword(s):

Septic Arthritis ◽

Temporomandibular Joint ◽

Nutritional Assessment ◽

Acute Otitis Media ◽

Clinical Signs ◽

Rare Condition ◽

Pediatric Emergency ◽

Ear Infections ◽

The Right

Abstract Background Otomastoiditis is a very frequent affection and a current complication of mal-treated benign ear infections in children. However, this a very rare case of the association of two rare complications of otomastoiditis in a newborn. On the one hand, septic arthritis of the temporomandibular joint which is a very rare condition that is difficult to diagnose, and when unrecognized or not treated accordingly, it can resolve in serious infectious complication and or definitive injury to the temporomandibular joint. On the other hand, osteomyelitis of the clavicle is also very rare, and only a few cases have been cited in the literature concerning infants. Case presentation This 46-day-old infant was brought to pediatric emergency consultation for 2 swelling inflammatory bulges, one in the right mastoid and pre-auricular regions, and another in the right basi-cervical area. The infant was hypertrophic febrile, hypotonic, and pale. He had preserved archaic reflexes. Besides, blood test showed an inflammatory syndrome, inflammatory anemia, and no other abnormalities. Upon supplementary computed tomodensitometry exam, the diagnosis of a combination of septic arthritis of the right temporomandibular joint and sub-periosteal abscess of the ipsilateral clavicle in a context of hypotrophy and malnutrition was suspected. A pus sample was obtained for bacteriological evaluation, after which the infant had a course of intravenous associated antibiotics, along with nutritional assessment and management. Surgical drainage of both collections was performed. The 6-month follow-up was satisfactory, without clinical signs of functional impact on temporomandibular joint, or acromioclavicular joint. Conclusion This work stresses the necessity of thorough clinical examination of infants even in cases of benign ear infections, as well as the importance of adapted treatment and follow-up, which could allow early diagnosis, appropriate treatment, or even prevention of severe complications that can be associated with such benign conditions.

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P686 Right atrial, right ventricular and pulmonary cement embolism: a rare complication of percutaneous vertebroplasty

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.362 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Akhunova ◽

R Khayrullin ◽

N Stekolshchikova ◽

M Samigullin ◽

V Padiryakov

Keyword(s):

Pulmonary Artery ◽

Right Ventricle ◽

Right Atrium ◽

Percutaneous Vertebroplasty ◽

Rare Complication ◽

Clinical Manifestations ◽

Stable Condition ◽

Right Atrial ◽

Cement Embolism ◽

The Right

Abstract A 68-year-old man was admitted to the hospital with complaints of pain in the lumbar spine. He had L5 disc herniation, Spinal stenosis of the L5 root canal - S1 on the right in the past medical history. Percutaneous vertebroplasty at the level of L3 and Th8 vertebral bodies was performed six months ago due to painful vertebral hemangioma. The man is suffering from arterial hypertension, receives antihypertensive therapy. During routine transthoracic echocardiography, a hyperechoic structure with a size of 9.5 x 0.9 cm was found in the right atrium and right ventricle. Chest computed tomography with contrast enhancement revealed signs of bone cement in the right atrium and right ventricle, in the right upper lobe artery, in the branches of the upper lobe artery, in the paravertebral venous plexuses. Considering the duration of the disease, the stable condition, the absence of clinical manifestations and disorders of intracardiac hemodynamics, it was decided to refrain from surgical treatment. Antiplatelet therapy and dynamic observation were recommended. Conclusion Percutaneous vertebroplasty is a modern minimally invasive surgical procedure for the treatment of degenerative-dystrophic diseases of the spine. However, the cement can penetrate into the paravertebral veins and migrate to the right chambers of the heart and the pulmonary artery. This clinical case demonstrates asymptomatic cement embolism of the right chambers of the heart and pulmonary artery after percutaneous vertebroplasty, detected incidentally during routine echocardiography. Abstract P686 Figure.

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A rare encounter of obstructed direct inguinal hernia

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v22i2.28745 ◽

2019 ◽

Vol 22 (2) ◽

pp. 41-43

Author(s):

Amit Kumar Singh ◽

Nripesh Rajbhandari ◽

Balaram Malla ◽

Gakul Bhatta

Keyword(s):

Emergency Department ◽

Inguinal Hernia ◽

Intestinal Obstruction ◽

Intestinal Resection ◽

Posterior Wall ◽

Acute Intestinal Obstruction ◽

University Hospital ◽

Direct Inguinal Hernia ◽

Direct Hernia ◽

The Right

The direct inguinal hernia has a wider neck and thus usually doesn’t present as strangulation or incarceration in comparison to the indirect component. When direct inguinal hernias are untreated for a longer duration, they may get strangulated and incarcerated. Hence such long-standing direct hernias with features of intestinal obstruction and /or peritonism should be promptly seen and diagnosed to prevent massive and unwanted intestinal resection. We are reporting a case of 83-year-old male presented to Surgical Emergency Department of Dhulikhel Hospital, Kathmandu University hospital with complaints of swelling in the right inguinoscrotal region for 12 years and progressed to become irreducible and painful for 12 hours. Clinically he had an acute intestinal obstruction. Intra-operatively we found a direct hernia containing congested small bowel loops and toxic fluids. The toxic fluid was suctioned and after confirming viability, modified Bassini’s repair was done with reinforcement of the posterior wall. Even direct inguinal hernia of longer duration can cause acute or sub-acute intestinal obstruction with or without features of peritonism. This complication is more common in elderly patients.

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Intraocular Lens Dislocation after Cataract Surgery in Tambolaka, Southwest Sumba, Indonesia: A Case Report

Case Reports in Ophthalmology ◽

10.1159/000487228 ◽

2018 ◽

Vol 9 (1) ◽

pp. 179-184

Author(s):

Ratna Sitompul

Keyword(s):

Case Report ◽

Intraocular Lens ◽

Rural Areas ◽

Rare Complication ◽

Cataract Extraction ◽

Factors Affecting ◽

Intraocular Lens Dislocation ◽

Post Surgery ◽

The Right ◽

Iol Dislocation

Intraocular lens (IOL) dislocation is a rare complication of cataract extraction requiring prompt surgery. This case report aims to raise awareness of such cases and the importance of post-surgery follow-up. A 58-year-old female patient was found with anterior IOL dislocation a week after phacoemulsification surgery in her right eye. Visual acuity of the right eye was 1/60 with ciliary injection and IOL dislocation to the anterior chamber of the right eye. The patient underwent surgery of the right eye and the IOL haptic was found to be broken. In this case report, the factors affecting IOL dislocation are axis length, broken IOL haptic, and patient activity that increased intraocular pressure. Cataract extraction surgery, although common, needs to be conducted carefully, and it is important for ophthalmologists and general practitioners to detect this condition, especially in rural areas where facilities are limited, as IOL dislocation could occur and requires immediate treatment to achieve a better result.

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Machine-learning algorithm that can improve the diagnostic accuracy of septic arthritis of the knee

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06418-2 ◽

2021 ◽

Author(s):

Eun-Seok Choi ◽

Jae Ang Sim ◽

Young Gon Na ◽

Jong- Keun Seon ◽

Hyun Dae Shin

Keyword(s):

Machine Learning ◽

Emergency Department ◽

Confidence Interval ◽

Diagnostic Accuracy ◽

Septic Arthritis ◽

Inflammatory Arthritis ◽

Supervised Machine Learning ◽

Diagnostic Model ◽

Extreme Gradient Boosting ◽

Wbc Count

Abstract Purpose Prompt diagnosis and treatment of septic arthritis of the knee is crucial. Nevertheless, the quality of evidence for the diagnosis of septic arthritis is low. In this study, the authors developed a machine learning-based diagnostic algorithm for septic arthritis of the native knee using clinical data in an emergency department and validated its diagnostic accuracy. Methods Patients (n = 326) who underwent synovial fluid analysis at the emergency department for suspected septic arthritis of the knee were enrolled. Septic arthritis was diagnosed in 164 of the patients (50.3%) using modified Newman criteria. Clinical characteristics of septic and inflammatory arthritis were compared. Area under the receiver-operating characteristic (ROC) curve (AUC) statistics was applied to evaluate the efficacy of each variable for the diagnosis of septic arthritis. The dataset was divided into independent training and test sets (comprising 80% and 20%, respectively, of the data). Supervised machine-learning techniques (random forest and eXtreme Gradient Boosting: XGBoost) were applied to develop a diagnostic model using the training dataset. The test dataset was subsequently used to validate the developed model. The ROC curves of the machine-learning model and each variable were compared. Results Synovial white blood cell (WBC) count was significantly higher in septic arthritis than in inflammatory arthritis in the multivariate analysis (P = 0.001). In the ROC comparison analysis, synovial WBC count yielded a significantly higher AUC than all other single variables (P = 0.002). The diagnostic model using the XGBoost algorithm yielded a higher AUC (0.831, 95% confidence interval 0.751–0.923) than synovial WBC count (0.740, 95% confidence interval 0.684–0.791; P = 0.033). The developed algorithm was deployed as a free access web-based application (www.septicknee.com). Conclusion The diagnosis of septic arthritis of the knee might be improved using a machine learning-based prediction model. Level of evidence Diagnostic study Level III (Case–control study).

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Pneumocephalus Following Self-Inflicted Penetrating Brain Injury

Case Reports in Otolaryngology ◽

10.1155/2017/7878646 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Che-Fang Ho ◽

Yuan-Yun Tam ◽

Chia-Chen Wu

Keyword(s):

Rare Complication ◽

Bed Rest ◽

Morbidity And Mortality ◽

High Morbidity ◽

Adequate Treatment ◽

Cerebrospinal Fluid Rhinorrhea ◽

Intravenous Antibiotics ◽

Computed Tomography Scans ◽

Intravenous Hydration ◽

Prompt Diagnosis

Objective. Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality. Material and Method. We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs. Result. Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication. Conclusion. Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.

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