Cases reported "Synovitis"

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1/6. A rare combination of sites of involvement by Mycobacterium intracellulare in a hemodialysis patient: multifocal synovitis, spondylitis, and multiple skin lesions.

    PURPOSE: Atypical mycobacterial infection is a rare but serious hazard in immunocompromised patients including those undergoing maintenance hemodialysis and immunosuppressive therapy. Recognition of unusual involvement patterns is important. methods: We describe an extremely rare combination of complications caused by such an organism in a patient with end-stage renal disease: spinal osteolysis and multiple skin lesions associated with synovitis. RESULTS: The patient had received a renal allograft 18 years previously but developed infection with mycobacterium avium-M. intracellulare complex including dermatologic manifestations, spondylitis, and synovitis involving the wrist and lateral malleolus after initiation of hemodialysis when the transplanted kidney failed. An empirical antibiotic regimen failed to alleviate skin lesions or fevers, or to lower an elevated c-reactive protein concentration, until the patient's dose of methylprednisolone was increased to treat mild adrenal insufficiency. The increase resulted in rapid resolution of skin lesions. A compression fracture 6 months later was attributed to spondylitis caused by the same organism. CONCLUSIONS: We suspect that spondylitis represented the primary focus of M. intracellulare infection.
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ranking = 1
keywords = osteolysis
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2/6. Talo-patello-scaphoid osteolysis, synovitis, and short fourth metacarpals in sisters: a new syndrome?

    osteolysis syndromes are characterized by resorption of affected bones with associated swelling and pain. Various forms of multicentric osteolysis syndromes including autosomal dominant and recessive carpal-tarsal osteolysis, Torg, Francois, Whyte-Hemingway, Hajdu-Cheney, Winchester, and other forms have been described. Most present in pre-school years with extensive involvement and destruction of multiple bones. We present a sister-pair, both of whom presented in early teenage, i.e., 13 and 15.5 years, respectively, with bilateral ankle, knee, and later, wrist pain. Radiological examination revealed bilateral osteolysis of tali, scaphoids, and patellae, and short fourth metacarpals in both sisters. Further investigation revealed absence of renal involvement, a normal excretion of amino acids, mucopolysaccharides and oligosaccharides, and presence of chronic synovitis in both sisters. Both parents and a younger brother were without radiographic or clinical evidence of the disease and there was no history of consanguinity. Thus, our sister-pair presented with the same carpal and tarsal bone involvement at a much later age, with evidence of chronic synovitis, along with short fourth metacarpals (brachydactyly type E changes) and without renal disease, suggesting a new syndrome with probable autosomal recessive inheritance.
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ranking = 7
keywords = osteolysis
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3/6. Intracarpal synovitis related to Dacron interposition after trapeziectomy: a report of three cases.

    To prevent the mechanical consequences of trapeziectomy, interposition devices are promoted, such a Dacron spacer. We report three cases of osteolysis and synovitis related to the use of such a device. This phenomenon occurred 4 months after insertion and required revision surgery after 9 months of follow-up because of pain and extensive osteolysis of the carpal bones. Revision consisted of an extended synovectomy, removal of the broken Dacron followed by a ligamentoplasty using the Flexor Carpi Radialis. Two years after revision surgery the result was satisfactory, with no recurrence of pain or osteolysis. The Dacron device did not demonstrate improvement in clinical results after short-term follow-up when compared to conventional ligamentoplasty. We recommend cautious use of the Dacron device at trapeziectomy and attention must be paid to follow up of the patient.
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ranking = 3
keywords = osteolysis
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4/6. Case report 590: Diffuse pigmented villonodular synovitis with a cartilaginous component.

    The authors present the case of a patient 54 years of age who developed well-defined osteolysis in the distal end of the humerus, with a slight radiodensity in the soft tissue. The radionuclide scintigram and above all the CT, were useful in defining the characteristics and expansion of the mass more precisely. Surgical intervention and histological examination demonstrated a seemingly unique case of PVNS of the elbow with diffuse cartilaginous components and erosion of the distal end of the humerus. The pathological findings in this unusual case, actually suggested the possibility of an intermediate form of PVNS associated with synovial chondromatosis.
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ranking = 1
keywords = osteolysis
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5/6. The use of differential scintigraphy in the clinical diagnosis of osseous and soft tissue changes affecting the diabetic foot.

    Prompt recognition of cellulitis, osteomyelitis, diabetic osteolysis, Charcot neuroarthropathy, septic synovitis, and deep plantar abscesses in the diabetic foot is essential because the therapy is drastically different. Differential diagnosis has been greatly facilitated by recently developed scanning techniques.
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ranking = 1
keywords = osteolysis
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6/6. osteolysis with detritic synovitis. A new syndrome.

    A new pattern of osteolysis accompanied by detritic synovitis occurred in a 71-year-old woman. The patient had a severe, destructive, and multilating arthropathy of her hands, with distal phalangeal deformity. Radiographs outlined bone resorption of the appendicular and axial skeleton, with involvement of phalanges, metacarpals, metatarsals, clavicles, long bones, and spine. There was no notable occupational history nor laboratory evidence of hyperparathyroidism. Pathological evaluation revealed synovial ulceration and necrosis, and necrotic bone embedded with fibrotic synovium. This patient's abnormalities appear to represent a new pattern of osteolysis that can be distinguished from other disorders.
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ranking = 2
keywords = osteolysis
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