11/286. A point mutation in a domain of gamma interferon receptor 1 provokes severe immunodeficiency.Gamma interferon (IFN-gamma) and the cellular responses induced by it are essential for controlling mycobacterial infections. Most patients bearing an IFN-gamma receptor ligand-binding chain (IFN-gammaR1) deficiency present gross mutations that truncate the protein and prevent its expression, giving rise to severe mycobacterial infections and, frequently, a fatal outcome. In this report a new mutation that affects the IFN-gammaR1 ligand-binding domain in a Spanish patient with mycobacterial disseminated infection and multifocal osteomyelitis is characterized. The mutation generates an amino acid change that does not abrogate protein expression on the cellular surface but that severely impairs responses after the binding of IFN-gamma (CD64 and HLA class II induction and tumor necrosis factor alpha and interleukin-12 production). A patient's younger brother, who was also probably homozygous for the mutation, died from meningitis due to mycobacterium bovis. These findings suggest that a point mutation may be fatal when it affects functionally important domains of the receptor and that the severity is not directly related to a lack of IFN-gamma receptor expression. Future research on these nontruncating mutations will make it possible to develop new therapeutical alternatives in this group of patients.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
12/286. Large cell lymphoma of bone presented by limp.We present a rare case of anaplastic large cell lymphoma of the bone in the leg of a child. The patient initially presented with suspected osteomyelitis of the fibula and was treated by antibiotics without apparent success. Thereafter, an open biopsy of the lesion was performed and the correct diagnosis was established. This rare case demonstrates the difficulties that a treating physician meets in establishing the correct diagnosis in a child presenting with limping. A review of the pertinent literature is introduced.- - - - - - - - - - ranking = 2.5keywords = cell (Clic here for more details about this article) |
13/286. mycobacterium xenopi osteomyelitis in a patient on highly active antiretroviral therapy (HAART).Skeletal infections with atypical mycobacteria are a manifestation of advanced hiv disease, most patients having CD4 counts of less than 100 cells/mm(3). We report a case of mycobacterium xenopi vertebral osteomyelitis in a patient on HAART with a CD4 count of 490 cells/mm(3) and viral load below the level of detection at the time of diagnosis.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
14/286. Osteoarticular brucellosis with long latent period.We describe the case of a young male who manifested brucella suis osteomyelitis after a 5-year period of relapsing monoarthritis. We discuss some of the difficulties regarding the diagnosis of osteoarticular brucellosis and review presentation patterns of the disease.- - - - - - - - - - ranking = 3keywords = cell (Clic here for more details about this article) |
15/286. Pyogenic vertebral osteomyelitis.Pyogenic vertebral osteomyelitis is a disease of adults that should be distinguished from true disk space infection. It is due to a hematogenous seeding (either venous or arterial) of the subchondral bony elements of the vertebral body. The disk space is involved secondarly, later in the course of the disease. The underlying bacteremia is from another focus of infection, frequently in the urinary tract. Disk space infection in adults is caused by direct violation of the disk, most commonly at the time of surgical excision of the nucleus pulposus. The bony elements of both adjacent vertebral bodies are secondarily involved. The clinical feature common to both types of infection is back pain that generally begins insidiously and then gradually increases in severity and becomes continuous and is accompanied by marked muscle spasm. The sedimentation rate is always increased; it decreases only with resolution of the infection. The diagnosis of vertebral infection is often not suspected because fever and leukocytosis generally are absent. The most common organism is staphylococcus aureus, although gram-negative bacterial infections also occur. Bacteriologic diangosis should be sought in each case by blood cultures (generally negative with postoperative disk space infection) or percutaneous needle biopsy. Soft tissue abscesses may require open debridement and drainage. Treatment of both types consists of rest, immobilization, and specific antibiotic treatment. The prognosis for resolution of the infectious process within six to nine months, with adequate treatment, is excellent.- - - - - - - - - - ranking = 0.5keywords = cell (Clic here for more details about this article) |
16/286. Paravertebral abscess formation due to brucellosis in a patient with ankylosing spondylitis.It is occasionally difficult to distinguish the features of spinal brucellosis from those of ankylosing spondylitis (AS), and the resultant delayed diagnosis may allow insidious progression of the complications of the brucella infection. The case of a 33-year-old male HLA-B27-positive patient with known diagnosis of AS for 7 years, who developed a paravertebral abscess in the left erector spinae muscle due to brucellosis, is presented in this paper. This case report illustrates two important points; first, co-occurrence of AS and brucellosis in the same patient, and second, posterior element involvement with abscess formation in erector spinae muscle, which has not been previously reported. magnetic resonance imaging is a sensitive method for detecting spinal brucellosis and extent of infection throughout paravertebral structures. Clinicians serving patients from areas with endemic brucellosis should not overlook the possibility of this infection in the presence of axial musculoskeletal symptoms, even among patients with AS.- - - - - - - - - - ranking = 5keywords = cell (Clic here for more details about this article) |
17/286. Diagnosis of calcium pyrophosphate dihydrate deposition disease by fine needle aspiration biopsy: a case report.BACKGROUND: calcium pyrophosphate dihydrate deposition disease is a relatively rare disease with variable clinical presentations. CASE: A 73-year-old man presented with worsening lower back pain and fever. Fine needle aspiration biopsy of the lumbar vertebral bodies (L3-L4) revealed abundant neutrophils admixed with small, birefringent, rhomboid crystals in Diff-Quik-stained smears. These crystals were confirmed as calcium pyrophosphate dihydrate on cell block sections. A diagnosis of osteomyelitis and calcium pyrophosphate dihydrate deposition disease was rendered. The patient was treated with antibiotics and responded well. CONCLUSION: calcium pyrophosphate dihydrate deposition disease can be diagnosed by fine needle aspiration biopsy, and an accurate diagnosis can be greatly facilitated by cell block sections. However, such a diagnosis may be neglected if the specimen is not carefully inspected.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
18/286. Genetic basis of patients with bacille Calmette-Guerin osteomyelitis in japan: identification of dominant partial interferon-gamma receptor 1 deficiency as a predominant type.Interferon (IFN)-gamma-mediated immunity plays an important role in host defense against intracellular pathogens, especially mycobacteria. Six Japanese children with bacille Calmette-Guerin (BCG) osteomyelitis were evaluated (1 disseminated, 3 multiple, and 2 solitary types) for mutations of genes involved in interleukin-12-dependent, IFN-gamma-mediated immunity. Heterozygous small deletions with frameshift (818del4 and 811del4) that are consistent with the diagnosis of partial dominant IFN-gamma receptor 1 (IFN-gammaR1) deficiency were detected in 3 unrelated patients. Expression of IFN-gammaR1 on monocytes was significantly increased in all 3 patients. Screening of family members with recurrent and disseminated mycobacterial infections found the identical deletion in 1 of the fathers. Antimycobacterial treatment was effective in these patients and resulted in good clinical outcome. This study demonstrated that partial dominant IFN-gammaR1 deficiency was the most common in Japanese patients who showed predisposition to curable BCG osteomyelitis.- - - - - - - - - - ranking = 0.5keywords = cell (Clic here for more details about this article) |
19/286. Pasteurella canis osteomyelitis and cutaneous abscess after a domestic dog bite.The genus Pasteurella is part of the normal oral flora of many animals, including domestic cats and dogs. In humans, Pasteurella may cause complications ranging from cellulitis to septicemia but rarely causes osteomyelitis or septic arthritis after bites and/or scratches by cats and dogs. Although pasteurella multocida is a common cause of infection, other Pasteurella species have also been cultured from wounds in humans. We describe here, a case of a cutaneous abscess and acute osteomyelitis associated with P canis after a domestic dog bite. To our knowledge, no previous case of P canis has been reported as the cause of acute osteomyelitis in humans.- - - - - - - - - - ranking = 0.5keywords = cell (Clic here for more details about this article) |
20/286. Localized osteomyelitis due to mycobacterium avium complex in patients with Human Immunodeficiency Virus receiving highly active antiretroviral therapy.We describe 3 patients who developed atypical manifestations of mycobacterium avium complex (MAC) infection >10 months (range, 3-16 months) after attaining sustained CD4( ) T cell counts of >100 cells/microL while receiving antiretroviral therapy and not receiving MAC prophylaxis. The common features of these cases include the degree of immune reconstitution, the unusual locations of the infections, and the absence of a systemic inflammatory response. The low rate of these unusual MAC infections does not warrant continuation of primary or secondary prophylaxis after presumed immune reconstitution.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
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