Cases reported "Arthritis, Infectious"

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1/18. Septic arthritis of a lumbar facet joint caused by staphylococcus aureus.

    STUDY DESIGN: Case report of a 35-year-old woman with septic arthritis of a lumbar facet joint. OBJECTIVES: To report a rare case of severe low back pain and the specific differential diagnostic problems. SUMMARY OF BACKGROUND DATA: Differential diagnosis between spondylodiscitis and facet joint septic arthritis on a clinical basis is very difficult. The lesions of the joint appear on a plain film only approximately 1.5 months after onset of the symptoms. Although the radionuclide bone scan is sensitive and shows a more laterally and vertically localized uptake than in spondylodiscitis, this technique is not very specific. Computed tomography scan and magnetic resonance imaging are the most reliable investigations even at the very early stages of the disease. Confirmation of the diagnosis has to be obtained by blood cultures or, in exceptional cases, by direct puncture of the joint. Appropriate antibiotic treatment is in most cases sufficient to heal this lesion. methods: The etiology, clinical presentation, technical examinations, and treatment are reviewed. RESULTS: Computed tomography scan and magnetic resonance imaging complemented by positive blood cultures led to the very early diagnosis of septic arthritis of the lumbar facet joint in this relatively young patient. CONCLUSIONS: With our case report we confirm the very small number of data reported in the literature, indicating that infections of the facet joint can be detected at a very early stage using magnetic resonance imaging and computed tomography scan.
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2/18. Septic arthritis of a lumbar facet joint due to pyonex.

    We present a case of septic arthritis of a lumbar facet joint with an associated epidural abscess. A 13-year-old boy was hospitalized with acute severe back pain and fever after pyonex was done. The infection was precisely localized with magnetic resonance imaging, bone and gallium scintigraphy. He responded to antibiotic therapy. We suppose that the infection was caused by pyonex because the blood cultures were negative, and the patient had an abrupt onset of severe pain and fever 24 h after the acupuncture.
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3/18. Acupuncture-associated arthritis in a joint with an orthopaedic implant.

    Viral infection is a well-recognized complication of acupuncture therapy. Bacterial infection however is rare. We report a rare case of intra-articular bacterial knee infection due to inadvertent acupuncture needle penetration.
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4/18. Group B streptococcus endogenous endophthalmitis : case reports and review of the literature.

    PURPOSE: To report five cases of group B streptococcus endogenous endophthalmitis (GBSEE) and to review the literature. DESIGN: Retrospective, noncomparative, interventional case series and literature review. patients: All patients with this condition treated at the singapore National eye Centre from 1994 through 2001. INTERVENTIONS: Core or complete vitrectomy and intravitreal and systemic antibiotics. methods: A review of the systemic and ocular characteristics and treatment. MAIN OUTCOME MEASURE: Visual outcome. RESULTS: Group B streptococcus endogenous endophthalmitis developed in four patients after the onset of septic arthritis and in one patient with cervical epidural abscess after acupuncture, presenting as a diffuse endophthalmitis. Group B streptococcus was isolated in the blood, vitreous, and joints. Despite the use of high-dose intravenous antibiotics within 72 hours of ocular presentation, intravitreal antibiotic injection, and vitrectomy (two eyes), all eyes lost light perception and became phthisical. A survey of the literature revealed that GBSEE is rare and that 17 cases have been reported since 1985. For purposes of analysis, four of these cases were excluded because of inadequate details and our five cases were included. Group B streptococcus endogenous endophthalmitis was found to arise from hematogenous spread from cutaneous sites of infection (16.7%), pharyngitis (11.1%), and pneumonia (11.1%). Septic arthritis (38.9%) and endocarditis (33.3%) were concomitant sites of infection along with endophthalmitis. The septic arthritis typically involved multiple joints. Four patients (22.2%) had diabetes mellitus and three had other underlying predisposing illness. Although most patients received intravenous (83.3%) and intravitreal (55.6%) antibiotics and four eyes underwent therapeutic vitrectomy, useful vision was preserved in only four eyes. Two patients died of sepsis. CONCLUSIONS: Group B streptococcus endogenous endophthalmitis is a devastating condition often associated with septic arthritis. The visual prognosis is poor, despite therapy.
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5/18. Catfish spine envenomation: a case of delayed presentation.

    Catfish spine envenomations can result in debilitating hand problems. Virulent bacteria may be introduced through a puncture wound. An offending organism may be difficult to culture, and a foreign body may be missed unless there is a high index of suspicion. The majority of cases present early and symptoms resolve within 3 months. We report a markedly delayed presentation and treatment of a catfish "finning" injury that resulted in chronic tenosynovitis to the hand. A review of the literature and current treatment recommendations are provided.
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6/18. Bone and joint infection after traumatic implantation of scedosporium prolificans treated with voriconazole and surgery.

    scedosporium prolificans is an environmental mould that may cause local infection in bone and joints after traumatic implantation, or generalized infection in immunocompromised patients. The fungus is highly drug resistant, both in vitro and in vivo. We present a case of osteomyelitis and arthritis caused by S. prolificans in a 9-y-old boy whose knee had been punctured by a hawthorn spike. Treatment with different drugs was difficult and arthrodesis was necessary. Concomitantly, voriconazole was given, and after three months bone biopsies were sterile despite a high in vitro MIC-value of the fungus against voriconazole. Reversible skin depigmentation and fingernail oncholysis appeared toward the end of 17 months of voriconazole treatment. Twelve months after discontinuation of treatment, no signs of relapse were detected. CONCLUSION: Voriconazole may be a valuable adjunct to surgical treatment of bone and joint infection by scedosporium prolificans.
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7/18. Recurrent arthritis as presenting symptom of osteomyelitis.

    We present a patient who had one episode of prepatellar bursitis and subsequently several episodes of arthritis of his right knee. Cultures of several punctures of his knee remained sterile, but the patient had been taking oral antibiotics on each of these occasions against our medical advice. Ultimately a diagnostic puncture revealed growth of staphylococcus aureus. An X-ray demonstrated an osteolytic lesion of the patella, but no defect in the articular surface of the patella could be visualised. MRI demonstrated a communication between the osteomyelitic focus through the medial retinaculum to the bursa suprapatellaris and the knee joint. osteomyelitis of the patella is mainly a disease of childhood. This case is, to our knowledge, the first report on the association between bursitis, osteomyelitis of the patella and recurrent septic arthritis of the knee in an adult. The literature is reviewed and discussed briefly.
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8/18. Unilateral septic arthritis of a lumbar facet joint secondary to acupuncture treatment--a case report.

    This report describes a case of septic arthritis of the lumbar facet joint probably as a result of acupuncture treatment. A 48 year old man with a long history of back pain presented with a two week history of increasing pain following a third session of acupuncture. Examination revealed tenderness in the right lumbosacral area and laboratory investigations revealed raised inflammatory markers with negative blood cultures. A bone scan and MRI scan showed evidence of septic arthritis of the right L5/S1 facet joint. An x ray computed tomography guided biopsy was carried out which isolated staphylococcus aureus. The patient was initially treated with intravenous antibiotics. A repeat MRI scan demonstrated persistent septic arthritis with adjacent early abscess formation. Surgical debridement of the facet joint was therefore performed. The patient had resolution of his symptoms and the inflammatory markers returned to normal. He regained a full range of movement of the lumbar spine. Very few cases have been reported of lumbar facet joint septic arthritis and this condition is rare in association with acupuncture treatment. A high index of suspicion needs to be maintained and if conservative management fails then debridement can result in an acceptable outcome.
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9/18. Staphyloccocal scalded skin syndrome in an adult.

    We report a case of staphyloccocal scalded skin syndrome due to an oxacillin-susceptible staphylococcus aureus in an 81-year-old woman. The patient was admitted to the emergency room with arthritis of the left shoulder, ten days after an intra-articular injection of corticosteroids. The shoulder's puncture showed a purulent liquid and gram positive cocci in cluster suggesting the presence of Staphylococcus sp. on the Gram-stain. The culture confirmed the identification of an oxacillin-susceptible staphylococcus aureus. Before administration of any dose of oxacillin, blisters appeared on the skin, that quickly ruptured, particulary in areas of friction. The exfoliated areas were extensive and resolution of all the lesions was reached after 3 weeks. The skin biopsy showed superficial epidermolysis confirming the diagnosis. Staphyloccocal scalded skin syndrome is usually described in neonates and young children, often in outbreaks. Few cases have been reported in adults, most often associated with severe underlying diseases. The mortality rate is low in children but can reach almost 60% in adults. The most important diagnosis to exclude is Lyell's syndrome which can be done by the skin biopsy.
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10/18. Microfilarial polyarthritis in a massive loa loa infestation. A case report.

    A Cameroonian affected with massive loa loa infection developed febrile arthritis with involvement of both knees and the left ankle. Although the patient was first seen by us after one month of treatment with indomethacin, at this time the joints were still inflamed and microfilariae of loa loa were found in the synovial fluid. No other etiological mechanism was identified. Following the articular puncture and treatment with ketoprofen, the arthritis subsisted within a week. This is the first case to be studied in which arthritis during loasis has been explicitly documented by the presence of intra-articular microfilariae.
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