1/30. Chronic paronychia, osteomyelitis, and paravertebral abscess in a child with blastomycosis.blastomycosis is an unusual fungal infection in children. It is often a chronic infection characterized by granulomatous and suppurative lesions. Clinical manifestations include either pulmonary findings or disseminated disease. Disseminated blastomycosis usually begins with a lung infection that spreads to the skin, bones, and central nervous system. This is a case report of a child with chronic blastomycosis presenting with chronic paronychia, fever, cough, malaise, and back pain. The child underwent surgical drainage of a paravertebral abscess and administration of intravenous amphotericin b. He was discharged in good condition on oral therapy with ketoconazole. The literature on blastomycosis, with particular emphasis on clinical presentations and management, is reviewed. When the history and physical examination suggest a chronic granulomatous or disseminated disease, such as tuberculosis, the physician must include blastomycosis in the differential.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/30. Primary haematogenous osteomyelitis of the patella: a rare cause for anterior knee pain in an adult.Acute osteomyelitis of the patella is a very rare condition, which commonly affects children between the ages of 5-15 years. Primary haematogenous osteomyelitis in an adult usually occurs in patients with associated risk factors like intravenous drug abuse, hiv infection, and trauma. This report discusses a similar condition in a 46 year old women with no associated predisposing risk factors. The rarity of this condition and its atypical presentation should be borne in mind while treating an adult patient with anterior knee pain. Point tenderness over the patella should alert a physician to the possibility of osteomyelitis of the patella. The value of bone scan and computed tomography in the early stages to help diagnose this condition has been stressed. The literature has been reviewed and discussed briefly.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/30. 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 = 1keywords = physician (Clic here for more details about this article) |
4/30. Spontaneously infected cephalohematoma: case report and review of the literature.Spontaneously infected cephalohematomas are rare occurrences; only five cases have been reported previously. Uninfected cephalohematomas are common and usually resolve without treatment. However, physicians should be aware that cephalohematomas are potential sites for infection and may require aspiration for diagnosis and treatment. Untreated infected cephalohematomas may lead to osteomyelitis, epidural abscess, or subdural empyema. We present a case of a spontaneously infected cephalohematoma with an associated osteomyelitis which was successfully managed with drainage and long-term antibiotics. A review of the literature is also presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/30. Midfacial osteomyelitis in a chronic cocaine abuser: a case report.We describe the case of a 56-year-old man who was admitted for treatment of a progressive destruction of his hard palate, septum, nasal cartilage, and soft palate that had been caused by chronic cocaine inhalation. biopsy of the bony septum revealed acute osteomyelitis and an extensive overgrowth of bacteria and actinomyces-like organisms. There was no evidence of granuloma or neoplasm. The patient received intravenous ampicillin/sulbactam for 6 weeks, followed by lifetime oral amoxicillin. When there was no further evidence that destruction was progressing, the patient underwent nasal reconstruction with a cranial bone graft. The surgery was completed with no complications. To our knowledge, this is the first reported case of midfacial osteomyelitis associated with chronic cocaine abuse. The severity of this patient's complications, coupled with the success of his reconstructive surgery, makes this case particularly interesting. We believe that it is important for physicians to understand that septal perforation in a cocaine abuser should not be underestimated because it could result in a secondary bone infection. Nasoseptal destruction secondary to intranasal cocaine abuse is a result of cocaine's vasoconstrictive properties, and a decrease in the oxygen tension of intranasal tissue can facilitate the growth of anaerobic pathogens.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/30. osteomyelitis caused by paracoccidioides brasiliensis in a child from the metropolitan area of Rio de Janeiro.The authors describe a case of paracoccidioidomycosis in a 7-year-old girl from the city of Rio de Janeiro who initially presented to her physician with a lesion in her calcaneous which was misdiagnosed and treated as bacterial osteomyelitis. Later, cutaneous manifestations, lymph node enlargement, and hepatosplenomegaly developed and biopsy of the skin and cervical lymph nodes showed the fungus which was also present in the sputum. It is emphasized that paracoccidioides brasiliensis can be the cause of bone lesions in endemic areas of latin america and that response to treatment with amphotercin B is good.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/30. Acute hematogenous osteomyelitis of the pelvis in childhood: Diagnostic clues and pitfalls.Acute hematogenous osteomyelitis (AHOM) of the pelvis is a rare form of childhood osteomyelitis. Prompted by a recent case, we reviewed the 146 reported cases of pelvic AHOM published since 1966. Classical childhood AHOM of tubular bones usually occurs in older children (mean age, 8.1 y) as opposed to younger children (aged 2-5 y). It is more common in boys than in girls (male to female ratio = 1.5:1). The most common site is the ilium (40%), followed by the ischium (28%) and the pubis (15%). In contrast to AHOM of the long bones, trauma is an uncommon antecedent event in pelvic AHOM. The pain in pelvic AHOM may be referred to the hip, thigh, or abdomen, often leading to misdiagnosis. On average, the correct diagnosis is delayed for 12 days. Such delays have resulted in a permanent disability in 3.4% of the cases. If diagnosed and treated promptly, uneventful recovery can be anticipated in all patients. This case history and review of the literature may facilitate early recognition of pelvic AHOM by primary care physicians, as well as by pediatric or orthopedic specialists.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/30. Vertebral osteomyelitis mimicking bone metastasis in breast cancer patients.Vertebral osteomyelitis can be a diagnostic pitfall for physicians, since it is protean and often subtle in its clinical presentation. It can coexist with metastatic lesions or mimic vertebral bone metastasis. When it occurs in patients with breast cancer, who are prone to have bone metastasis, it can present perplexing diagnostic problems. Misdiagnosing vertebral osteomyelitis as bone metastasis or vice versa results in delayed diagnosis and inappropriate treatment and may cause serious morbidity. We emphasize this problem by presenting the cases of two patients with breast cancer whose clinical course was complicated by vertebral osteomyelitis. When the clinical course of breast cancer is different from this usual presentation, a different process should be suspected, and histologic diagnosis should be promptly sought. Fine-needle aspiration biopsy and culture of suspicious-appearing bony lesions is recommended as a rapid and reliable method of establishing a definite diagnosis in this circumstance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/30. Pelvic radiation necrosis and osteomyelitis following chemoradiation for advanced stage vulvar and cervical carcinoma.BACKGROUND: The treatment regimen indicated for most advanced stage vulvar, vaginal, and cervical cancer usually involves adjuvant chemoradiation therapy. Although the risk of complications is low, there have been reported cases of radiation necrosis and osteomyelitis following treatment for vulvar, vaginal, and cervical cancer. CASES: We present a vulvar cancer patient and a cervical cancer patient, both of whom were treated with radical surgery and postoperative chemoradiation. Following therapy, they were afflicted with pelvic radiation necrosis and osteomyelitis. The patients underwent surgery to resect the necrotic bone tissue and long-term antibiotic therapy to treat their osteomyelitis. They have since recovered and are followed closely by their gynecologic oncology and infectious disease physicians. CONCLUSION: The radiotherapy utilized to treat advanced stage gynecologic cancer can cause intestinal, vaginal, and urologic complications from micro-vascular damage to the organs. Pelvic bone osteonecrosis is a rare but disabling complication of pelvic radiation. Fortunately, with aggressive therapy, these patients may do well clinically.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/30. Hematogenous patellar osteomyelitis associated with human immunodeficiency virus.The case of a 37-year-old man with hematogenous osteomyelitis associated with the human immunodeficiency virus (hiv) is presented, with a review of the literature. Hematogenous osteomyelitis is a relatively rare entity in the patella; most cases have involved adolescents and immunocompromised patients. There have been no previous reports of hematogenous osteomyelitis in hiv-positive patients. The diagnosis requires clinical suspicion and roentgenographic evidence. Point tenderness over the patella and a painful, swollen knee joint are signs that should alert a physician to the possibility of hematogenous osteomyelitis. Laboratory studies are often of little value, and systemic symptoms are often absent. Treatment requires appropriately directed intravenous antibiotics and open drainage and curettage of the patella. Patellectomy may be required for large lesions and in instances of articular involvement. Computed tomography is a helpful diagnostic tool. The patient in this presentation had osteomyelitis of the patella with a knee pyarthrosis. He had open debridement of the extensor mechanism and knee joint, but ultimately required amputation because of repeat pyarthroses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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