1/21. agrobacterium yellow group: bacteremia and possible septic arthritis following peripheral blood stem cell transplantation.A 47-year-old male patient developed sepsis and monoarticular arthritis following autologous stem cell transplantation for recurrent Hodgkin's disease. Blood cultures were positive for agrobacterium yellow group. The knee pain and swelling responded promptly to the institution of empirical broad-spectrum antibiotics. Recurrent bacteremia developed necessitating Hickman line removal for eventual resolution of the infection. Transplant physicians should be aware of this unusual pathogen and the potential for both persistent line-related sepsis and possible septic arthritis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/21. A rare case of salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.We report the case of a 16-year-old female who was ultimately diagnosed with salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/21. Computed tomography in diagnosis of septic sacroiliitis: report of three cases.Disorders of the sacroiliac joint are often overlooked during an initial physical examination because the patient is usually in a supine position and the posteriorly located joint is not accessible. Local pain and tenderness at the sacroiliac joint on lateral compression of the pelvis, together with Gaenslen and Fabere maneuvers, may direct the physician's attention to the joint. However, these symptoms are not specific or pathognomonic. Unusual presentation of septic sacroiliitis, which does not show radiologic changes during the early stages, may mimic gluteal, lumbar disc or intra-abdominal syndromes, leading to unnecessary abdominal exploration or lumbar discectomy. Computed tomography (CT), with its superb delineation of osseous, synovial and peri-articular structures, was applied to diagnose septic sacroiliitis in three patients. In Patient 1, septic arthritis and juxta-articular osteomyelitis with sequestrum formation were demonstrated by CT four weeks before abnormalities were shown on a roentgenogram. In patients 2 and 3, inflammatory processes affected the synovium and peri-articular muscles; thus, abnormalities were shown by CT but not by a roentgenogram. We consider CT to be helpful and superior to conventional radiography in the diagnosis of septic sacroiliitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/21. hepatitis c virus associated arthritis in absence of clinical, biochemical and histological evidence of liver disease--responding to interferon therapy.BACKGROUND: Extrahepatic manifestations associated with hepatitis c virus (HCV) such as arthritis, vasculitis, cryoglobulinemia, are well known. However, HCV related arthritis in the absence of clinical, biochemical and histological evidence of liver disease is not common. This article deals with such a case and its response to interferon therapy. CASE REPORT: We present a case of a 32 year old Filipino male who presented with bilateral symmetrical painful swelling of multiple joints including, hands, elbows, shoulders, and knees. serum rheumatoid factor, antinuclear antibodies and a comprehensive work-up for rheumatologic disorders were all negative. Both initially and subsequently, serological tests for hepatitis a, B, and autoimmune liver diseases, Wilson's disease, hemochromatosis, syphilis, human immunodeficiency virus (hiv) and cryoglobulinemia were negative, initially and subsequently. However, the hepatitis c antibody test was positive and hepatitis c viral rna was detected in high titers. The joint symptoms did not improve despite therapy with nonsteroidal anti-inflammatory drugs and a short course of prednisone prescribed earlier by his primary care physician. The patient then requested and was subsequently treated with interferon alpha 2b. RESULTS: The patient responded rapidly to the interferon therapy with significant and sustained improvement in joint symptoms and disappearance of hepatitis c viral rna from his serum. CONCLUSIONS: HCV arthritis should be considered in the differential diagnosis of seronegative arthritis of undetermined etiology even in the setting of normal liver chemistries.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/21. A case of persistent parvovirus B19 infection with bilateral cartilaginous and ligamentous damage to the wrists.We describe a case of persistent parvovirus B19 infection in a 48-year-old female physician that was complicated by prolonged fatigue and arthritis associated with cartilaginous and ligamentous damage in both wrists. Nineteen months after presentation, intravenous immunoglobulin therapy resulted in clearance of parvovirus B19 viremia and a significant improvement in the symptoms of fatigue and arthritis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/21. Imaging infection with 18F-FDG-labeled leukocyte PET/CT: initial experience in 21 patients.The aim of this study was to assess the feasibility and the potential role of PET/CT with (18)F-FDG-labeled autologous leukocytes in the diagnosis and localization of infectious lesions. methods: Twenty-one consecutive patients with suspected or documented infection were prospectively evaluated with whole-body PET/CT 3 h after injection of autologous (18)F-FDG-labeled leukocytes. Two experienced nuclear medicine physicians who were unaware of the clinical end-diagnosis reviewed all PET/CT studies. A visual score (0-3)-according to uptake intensity-was used to assess studies. The results of PET/CT with (18)F-FDG-labeled white blood cell ((18)F-FDG-WBC) assessment were compared with histologic or biologic diagnosis in 15 patients and with clinical end-diagnosis after complete clinical work-up in 6 patients. RESULTS: Nine patients had fever of unknown etiology, 6 patients had documented infection but with unknown extension of the infectious disease, 4 patients had a documented infection with unfavorable evolution, and 2 patients had a documented infection with known extension. The best trade-off between sensitivity and specificity was obtained when a visual score of >or=2 was chosen to identify increased tracer uptake as infection. With this threshold, sensitivity, specificity, and accuracy were each 86% on a patient-per-patient basis and 91%, 85%, and 90% on a lesion-per-lesion basis. In this small group of patients, the absence of areas with increased WBC uptake on WBC PET/CT had a 100% negative predictive value. CONCLUSION: Hybrid (18)F-FDG-WBC PET/CT was found to have a high sensitivity and specificity for the diagnosis of infection. It located infectious lesions with a high precision. In this small series, absence of areas with increased uptake virtually ruled out the presence of infection. (18)F-FDG-WBC PET/CT for infection detection deserves further investigation in a larger prospective series.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/21. Acute Barmah Forest polyarthritis.More than 60 arboviruses have been isolated in australia with the human pathogenicity of the majority yet to be determined. Recent reports outline extensive clinical and sub-clinical infection occurring in Eastern australia by such agents as Ross River and Barmah Forest viruses. We describe the clinical features of two patients with an acute polyarthritis associated with serological evidence of acute Barmah Forest virus infection to alert physicians to this form of viral polyarthritis and highlight the need to consider this agent when confronted with patients with an acute 'viral-type' polyarthritis in whom serology for ross river virus is negative.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/21. Septic sacroiliitis due to proteus mirabilis.This case demonstrates the difficulty frequently encountered in making an early diagnosis of septic sacroiliitis. The proper use of appropriate laboratory tests and radiologic examinations can narrow the differential diagnosis significantly, with confirmation resting on culture results. Appropriate antibiotic therapy will depend on the organism isolated. When confronted by the typical clinical findings and supporting ancillary data of septic sacroiliitis, the physician should consider the possibility of an unusual organism such as proteus mirabilis and should direct antibiotic therapy accordingly.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/21. Increased risk of neisserial infections in systemic lupus erythematosus.survival in systemic lupus erythamatosus (SLE) continues to improve because of better ancillary care, earlier diagnosis, and earlier treatment. However, infection remains a leading cause of morbidity and mortality in this disease. Although corticosteroids and immunosuppresives increase the risk of opportunistic infection, the SLE patient is still most at risk from common bacterial pathogens. As the prototypic immune-complex disease, patients with active SLE have low circulating complement as well as a reticuloendothelial system (RES) saturated with immune complexes. It seems intuitive that SLE patients should be most at risk for organisms dependent for their removal on the RES or complement for opsonization or bacteriolysis. The current series presents four patients with SLE and disseminated neisseria infection and brings to 14 the number of patients in the literature with disseminated neisserial infection. They are typically young, female, with renal disease, and either congenital or acquired hypocomplementemia, and may present with all features of a lupus flare. Surprisingly, they are not all on corticosteroids or immunosuppressives and have some features that are unusual for non-SLE patients with these infections. There seems to be an over-representation of Nisseria meningitidis (despite potential reporting bias), and there ironically may be better tolerance with fewer fulminant complications in patients who have complement deficiencies. The best approach for the physician treating SLE is to immunize all SLE patients with available bacterial vaccines to N meningitidis and streptococcus pneumonia, have a low threshold of suspicion for the diagnosis of disseminated neisserial or other encapsulated bacterial infection in the SLE patient who is sick, and to treat empirically with third generation cephalosporins after appropriate cultures.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/21. Septic arthritis: common pitfalls.The diagnosis of suppurative arthritis is a challenging task complicated by many pitfalls. The physician must rely on the basic skills of a history, physical examination, and index of suspicion to properly decipher the differential diagnosis, and the perceptive analysis of laboratory studies is essential. Prompt institution of treatment with antibiotics and effective cleansing of the joint are the key factors in achieving a good result.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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