1/12. Polyarthralgia-arthritis syndrome induced by low doses of rifabutin.We describe 2 cases of polyarthralgia-arthritis syndrome induced by rifabutin, an effective treatment for infections of Mycobacterium avium intracellulare complex. This syndrome has been reported with doses higher than 1 g per day when rifabutin is given in monotherapy. But our cases were treated with low doses, 300-450 mg per day, in combination with clarithromycin. The plasma concentration of rifabutin has been shown to be increased by clarithromycin, suggesting that co-prescription of clarithromycin could lead to development of rifabutin induced polyarthralgia-arthritis syndrome.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
2/12. Chronic destructive oligoarthritis associated with propionibacterium acnes in a female patient with acne vulgaris: septic-reactive arthritis?propionibacterium acnes is an anaerobic bacillus implicated in certain chronic arthritides. This report describes an HLA-B27 17-year-old woman with acne vulgaris who presented with rapidly destructive arthritis in the left shoulder as well as an evolving left subclavicular adenopathy. One year later, arthritis was detected in the left knee; the inflammatory synovial fluid was sterile. growth of P acnes was observed in cultures of the shoulder synovium and lymph nodes, but polymerase chain reaction was negative for borrelia, chlamydia, and ureaplasma dna. Three months of treatment with amoxicillin and rifampicin led to clinical disappearance of the oligoarthritis, but arthritis recurred in the left knee after discontinuation of therapy. On biopsy, bacteria were undetectable in the knee synovium, but chronic arthritis was evident histologically. Antibiotics were reintroduced for 12 months and were again effective against the clinical symptoms. Although the asymmetry, histologic features, arthritis-acne association, and genetic predisposition of this chronic destructive oligoarthritis would seem to indicate a reactive arthropathy, the isolation of P acnes from 2 distinct specimens prompted us to propose calling this a case of septic-reactive arthritis, which is further supported by the absence of progression after antibiotic therapy and the persistence of the rheumatism. To our knowledge, this is the first demonstration of the efficacy of prolonged antibiotic therapy on the joint manifestations of chronic rheumatism associated with acne.- - - - - - - - - - ranking = 5keywords = bacterium (Clic here for more details about this article) |
3/12. uveitis associated with rifabutin therapy.PURPOSE: To highlight the association of uveitis with the use of rifabutin. methods: Retrospective study of two patients with acute anterior uveitis. RESULTS: Both patients were receiving rifabutin for treatment of atypical Mycobacterium infection associated with AIDS when they developed unilateral acute anterior uveitis and arthritis. The inflammation resolved and vision improved with introduction of topical corticosteroids, mydriatics and cessation of rifabutin treatment. CONCLUSION: Use of rifabutin with clarithromycin may precipitate acute uveitis in patients with AIDS being treated for systemic mycobacterium avium complex infection. uveitis produced by rifabutin may be analogous to Herxeimer reaction as seen in syphilis. clarithromycin and fluconazole elevate levels of rifabutin due to inhibition of metabolism through cytochrome p-450 pathway. The differential diagnosis includes Reiter's syndrome, syphilis causing uveitis, metastatic endophthalmitis, and direct hiv-related uveitis.- - - - - - - - - - ranking = 2keywords = bacterium (Clic here for more details about this article) |
4/12. Lepromatous leprosy presenting with polyarthritis, myositis, and immune-complex glomerulonephritis.A Pakistani man aged 19 years was admitted to a rheumatological unit in the United Kingdom with acute widespread polyarthritis accompanied by night sweats and fever. Preliminary examination suggested Reiter's disease, but further investigation showed acute glomerulonephritis with uraemia. The possibility of periarteritis nodosa, and the prominence of muscle tenderness in the legs, led to biopsies of striated muscle and skin, in both of which were changes typical of lepromatous leprosy, with many mycobacterium leprae on Ziehl-Neelsen staining. serum showed IgG-IgM cryoglobulinaemia without antiglobulin activity, and in the recovery phase renal biopsy showed a resolving proliferative glomerulonephritis with linear IgG and IgM immunofluorescence and granular deposits of C3. Clinical signs subsided rapidly under steroid treatment and subsequent progress on anti-leprosy drugs was uneventful. The term erythema nodosum leprosum is inadequate and misleading as a title for a common and important immune-complex reaction of lepromatous leprosy, in which numerous body systems may be involved.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
5/12. Elimination of arthritis pain and inflammation for over 2 years with a single 90 min, topical 14% gallium nitrate treatment: case reports and review of actions of gallium III.Arthritis is inflammation in a joint often with joint damage, usually accompanied by pain, swelling and stiffness, resulting from infection, trauma, degenerative changes, metabolic disturbances, autoimmune or other causes. It occurs in various forms, including rheumatoid arthritis, osteoarthritis, bacterial arthritis and gout. gallium III can inhibit the production of inflammatory cytokines, such as IL-1beta, produced by macrophage-like cells in vitro. A dose-dependent inhibition of IL-1beta and TPA stimulated MMP activity by gallium nitrate at increasing concentrations occurs, demonstrating that gallium nitrate can be a useful modulator of inflammation in arthritis. gallium III is an inhibitor of bone resorption and is an effective treatment for hypercalcemia. gallium III has been reported to be effective in the treatment of mycobacterium butycicum-induced arthritis in rats by antagonism of iron III. Long-term elimination of pain from arthritis by gallium III was first observed in horses primarily being treated for navicular disease. Several people treating their horses with gallium nitrate coincidentally found that arthritis pain in their fingers ended and did not return after soaking their hands in 14% gallium nitrate solution. Therefore, the severely arthritic hands of a 60-year-old woman were topically treated with a 14% aqueous solution of gallium nitrate for 90 min. Pain and inflammation from rheumatoid arthritis diminished rapidly, and neither pain nor inflammation returned during the following 2 years from that single treatment. A 61-year-old woman who had osteoarthritis in her left knee, shoulders and wrists was treated orally with 50 ml of a 1% gallium nitrate solution (120 mg elemental gallium) daily using a two week on and two week off protocol, resulting in almost total elimination of pain while on gallium nitrate, while pain partially returned during the two week off periods. Treatment of frozen shoulder with topical 40% gallium nitrate for 120 min resulted in greatly reduced pain and crepitus almost immediately with complete restoration of range of motion, with pain remaining essentially absent for over 1 year. Mechanisms of action are hypothesized to include anti-inflammatory, bone density improvements, antibacterial, anti-iron III and anti-aluminum III effects. Proper use of gallium III may be effective in terminating pain and inflammation of arthritis for years, often with a single treatment.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
6/12. Acute polyarthritis following the use of corynebacterium parvum vaccine (Coparvax) for malignant pleural effusion.A 77-year-old man with a malignant pleural effusion was treated by aspiration of fluid and injection of corynebacterium parvum vaccine for pleurodesis. Within 24 hr he had developed a temperature and a neutropenia followed by an acute crippling polyarthritis of his hands and wrists which subsequently responded to oral steroids and non-steroidal antiinflammatory drugs.- - - - - - - - - - ranking = 5keywords = bacterium (Clic here for more details about this article) |
7/12. Metastatic complications of fusobacterium necrophorum sepsis. Two cases of Lemierre's postanginal septicemia.We have recently encountered two instances of septicemia due to fusobacterium necrophorum in adolescents. The presence of severe exudative pharyngitis in both patients pointed to the upper respiratory tract as the probable portal of entry. In one case, metastatic infection was manifested by multiple septic pulmonary emboli with associated pleural effusions. In the other case, diffuse encephalopathy and septic arthritis of the left shoulder and hip occurred. Unilateral neck pain, persistent bacteremia, and prolonged fever despite appropriate antibiotics were consistent with the presence of septic jugular thrombophlebitis in both patients. "Postanginal septicemia" caused by F necrophorum, described by Lemierre in the preantibiotic era, was undoubtedly the syndrome manifested by these patients. This condition, formerly uniformly fatal, can readily be diagnosed when anaerobic techniques are used for blood culture, but requires prolonged antibiotic therapy for cure.- - - - - - - - - - ranking = 5keywords = bacterium (Clic here for more details about this article) |
8/12. The diagnosis of Poncet's disease.Two cases of polyarthritis in young people with extra-articular tuberculosis are described. The clinical features were consistent with the concept of Poncet's disease. After synovial biopsy one patient proved to have tuberculous peripheral arthritis. This observation raised doubts about the diagnosis in the other patient. Multiple joints may be simultaneously infected with mycobacterium tuberculosis and Poncet's disease, if it exists, should not be entertained in the absence of synovial biopsy.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
9/12. Unusual features of osteoarticular tuberculosis in children.Three children with tuberculous arthritis, two of whom also had tuberculous otitis media, are described. Two of the children were atypical at presentation, with an acute onset of arthritis, an elevated erythrocyte sedimentation rate, and a predominance of polymorphonuclear cells in the joint fluid. Both had histories of recurrent otitis media with perforations. Recognition that mycobacterium tuberculosis could be the cause of disease in all three cases was delayed. Placement of a tuberculin skin test ultimately led to the correct diagnosis. These cases Illustrate that tuberculous arthritis is not always insidious in onset and underscore the need to maintain a high index of suspicion for tuberculosis infection in high-risk patient populations. Our experiences suggest that Mantoux skin tests might be considered part of the "routine" diagnostic study of children with arthritis or recurrent otitis media, especially in communities with high tuberculosis case rates.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
10/12. Propionibacterium avidum sacroiliitis and osteomyelitis.The anaerobic Gram-positive bacterium Propionibacterium avidum is a common inhabitant of the skin with low pathogenicity. We report a case of P. avidum sacroilitis, psoas abscess and osteomyelitis in a 67-year-old male who had recently undergone surgical repair of an inguinal hernia. The organism was recovered from blood cultures, a bone biopsy specimen and specimens from the abscess. The spectrum of bone and joint infections caused by Propionibacterium is discussed. infection by Propionibacterium spp. should be considered in patients with bone and joint infections.- - - - - - - - - - ranking = 8keywords = bacterium (Clic here for more details about this article) |
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