Cases reported "Discitis"

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21/49. salmonella spondylodiscitis in patients without sickle cell disease.

    The optimal treatment of salmonella spondylodiscitis is controversial. The cases of eight patients who had salmonella spondylitis without sickle cell disease were reviewed. Back pain (100%), fever (75%), and elevated c-reactive protein levels (100%) were common, but gastrointestinal symptoms were not (0%). Six patients had positive blood cultures, and the other two had positive tissue cultures. Group C1 salmonella was the most common serotype. Two patients with coexisting aortic mycotic aneurysms had immediate aneurysm resection. Three others responded favorably to appropriate antibiotics, and three required subsequent surgical reconstruction because of neurologic impairment or osseous instability. Clinical outcomes were significantly better than those of 46 previously reported patients. salmonella spondylodiscitis usually responds favorably to appropriate antibiotics; consequently, a tissue diagnosis is important. Operative interventions are necessary only for patients with coexisting aneurysms or ongoing osseous instability. A ruptured aortic aneurysm with pseudoaneurysm may mimic a paravertebral abscess, and surgery at the site of an unsuspected aneurysm may precipitate life-threatening hemorrhage. Satisfactory results may be depend on early surgical intervention for a mycotic aneurysm and also are related to host immunity.
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ranking = 1
keywords = abscess
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22/49. Extension of lumbar spine infection into osteoarthritic hip through psoas abscess.

    We present a case of pyogenic lumbar discitis and septic hip arthritis, accompanied by a psoas abscess and pyogenic iliopsoas bursitis, for which the correct diagnosis was delayed. The patho-mechanism was speculated to be initial hematogenous infection in the lumbar spine that spread along the psoas muscle as a psoas abscess and then extended into the hip joint via the iliopsoas bursa. For an early correct diagnosis, clinicians should be aware that the lumbar spine and hip joint regions communicate through the psoas muscle space and iliopsoas bursa, making it possible for infection to spread.
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ranking = 6
keywords = abscess
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23/49. Anaerobic spondylodiscitis: case series and systematic review.

    BACKGROUND: Bacterial spondylodiscitis is rarely caused by anaerobic organisms. We describe two patients with lumbar vertebral osteomyelitis and discitis caused by anaerobic bacteria, including an unusual occurrence after an endodontic procedure, and review the salient clinical features and outcomes of 31 previously reported cases. methods: case reports and review of the literature. RESULTS: Median age at presentation was 65 years, with a male-to-female ratio of 2:1. The most common presenting symptoms were back pain, fever, and neurologic deficits. The lumbar spine was most frequently involved (43%); an equal number of cases involved contiguous extension or hematogenous spread. Causative anaerobes were recovered from disk space or vertebrae (13), blood (4), and/or soft tissue abscess and included Bacteroides species (12), propionibacterium acnes (7), peptococcus species (4), peptostreptococcus species and clostridium species (3 each), corynebacterium diphtheroides and fusobacterium species (2 each), and unspecified anaerobes (3). CONCLUSIONS: Apart from specific antibiotic selection, medical treatment and outcomes for anaerobic spondylodiscitis are similar to those for aerobic vertebral disk infection.
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ranking = 1
keywords = abscess
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24/49. A case of brucella spondylodiscitis with extended, multiple-level involvement.

    brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse was seen with a combined treatment (doxycycline/rifampin) for 3 months, followed by doxycycline alone for 6 months. Almost all radiologic findings disappeared at the end of a 1-year follow-up without any further treatment.
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ranking = 1
keywords = abscess
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25/49. candida spondylodiscitis and epidural abscess: management with shorter courses of anti-fungal therapy in combination with surgical debridement.

    epidural abscess associated with candidal spondylodiscitis is rarely seen, particularly when it involves the cervical and thoracic spine. We report two such cases that were successfully managed with early surgical debridement, as well as medical therapy with intravenous amphotericin followed by oral fluconazole. The literature related to candidal spinal infection is reviewed, and a rational approach to the management of this uncommon condition is proposed. A good outcome may generally be expected with early diagnosis as well as appropriate surgical and pharmacological treatment. Oral fluconazole appears to be useful in the management of candida spondylodiscitis complicated by epidural abscess formation. Treatment until a normal ESR is attained is ideal, and this may be as short as 3 months when surgical drainage has been adequately performed.
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ranking = 6
keywords = abscess
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26/49. Skeletal infections in cirrhotics.

    There are few reports of skeletal infections in patients with cirrhosis. We present two such cases, both with alcoholic liver disease, seen over a period of one year. The first, a 46-year-old man, presented as pyrexia of unknown origin, and was found to have pyogenic discitis; he responded to antibiotic and surgery. The second, a 42-year-old man, presented with chest wall abscess and was diagnosed to have tubercular osteomyelitis; he expired despite treatment with non-hepatotoxic anti-tubercular drugs.
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ranking = 1
keywords = abscess
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27/49. Bone and joint infection due to streptococcus pneumoniae in two immunocompetent adults.

    Bone and joint infections due to streptococcus pneumoniae are uncommon in adults in the absence of risk factors (e.g. alcohol abuse, immunodepression, or preexisting joint disease). We report two cases in previously healthy adults. The clinical picture was septic arthritis of the knee in one patient and discitis with an extensive epidural abscess in the other. The characteristics of S. pneumoniae bone and joint infections are reviewed, with emphasis on risk factors. The therapeutic strategy is discussed in the light of the recent upsurge in S. pneumoniae strains with reduced susceptibility to penicillin.
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ranking = 1
keywords = abscess
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28/49. Could remembering the prozone phenomenon shorten our diagnostic journey in brucellosis? A case of brucella spondylodiscitis.

    We reviewed a case of brucella spondylodiscitis admitted to a referral, university hospital, in Ankara, turkey. A 75-year-old female was referred to our hospital with low back pain. Previous magnetic resonance imaging yielded cortical destruction of T9-10 and T12-L2 vertebral bodies, focal infectious foci at discs within this range, significant microabscesses at paravertebral areas, which lead to the diagnosis of spondylodiscitis. history of consumption of unpasteurized dairy products led us to first suspect brucellosis yet, the serum agglutination test and blood culture were negative and did mislead us to several other, sometimes invasive, diagnostic tests. The final diagnosis was reached by culturing the specimen obtained through fine-needle aspiration from the paravertebral microabscesses. The exhausting diagnostic journey that started with the suspicion of tuberculosis or malignancy ended with a diagnosis of brucellosis. brucellosis should be considered in all patients with osteoarthritic complaints in endemic regions, and the "prozone phenomenon" should be kept in mind, before proceeding to high-tech lab tests, imaging, or invasive procedures.
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ranking = 2
keywords = abscess
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29/49. Spondylodiscitis due to bacteroides fragilis: two cases and review.

    Non-iatrogenic spondylodiscitis caused by anaerobic bacteria remains exceptional. We describe 2 cases of spondylodiscitis with epidural abscess due to Bacteroides fragilis, 1 after colonoscopy with biopsy and 1 in a cirrhotic patient. The clinical and imaging findings were not discriminant relative to other pyogenic spondylodiscitis. One should consider B. fragilis when treating a spondylodiscitis with epidural abscess, especially in patients with a possibly digestive portal of entry.
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ranking = 2
keywords = abscess
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30/49. Brucellar spondylo-discitis with rapidly progressive spinal epidural abscess presenting with sciatica.

    STUDY DESIGN: Case report. OBJECTIVE: To present a patient with spinal brucellosis, which was initially presented with sciatica and misdiagnosed as a lumbar disc herniation owing to nonspecific neurological and radiological findings. The delay in diagnosis led to rapid progression of the disease and complications. SETTING: Department of neurosurgery at a tertiary university teaching hospital (Sutcu Imam University Medical Center in turkey). CASE REPORT: A 57-year-old woman with a history of low-back pain for 6 months, fatigue, and severe left-sided sciatica for the last 3 months presented to our hospital. Three months earlier, at another hospital, she had had a negative Rose-Bengal test for brucellosis and a lumbar computed tomography performed at that time showed only minimal L4-5 annular bulging. For 2 months, she was treated with analgesics for 'lumbar disc herniation' without relief of pain. On presentation to our department, her magnetic resonance imaging (MRI) examination showed edema and minimal annular bulging at L3-4 and L4-5. When her Rose-Bengal test returned positive, she was started on triple antibiotics for presumed brucella infection. When symptoms and neurologic signs worsened while taking antibiotics, repeat MRI scan showed a spinal epidural abscess at the L4-5 level. Emergent surgery and 8 weeks of antibiotics resulted in cure. CONCLUSION: In areas endemic for brucellosis, subtle historical and exam features should be sought to exclude an infection such as brucellar sponylo-discitis. Appropriate serological tests should be readily available to confirm or exclude this diagnosis in selected patients, to avoid delays in antibiotic treatment.
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ranking = 5
keywords = abscess
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