Calcaneal Osteomyelitis Presenting as a Paradoxical Reaction during Treatment of Multidrug-Resistant Tuberculosis

Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.

Prevalence and Risk Factors for Carbapenem-Resistant Enterobacteriaceae Colonization in Patients with Stroke

This retrospective case-control study investigated the prevalence and risk factors of carbapenem-resistant Enterobacteriaceae (CRE) colonization in stroke patients within 6 months of onset. Forty-three patients confirmed to have CRE colonization in our hospital from January 2017 to December 2018 were included in this study. The control group included 44 stroke patients who had carbapenem-susceptible Enterobacteriaceae colonization. The patients were age- (± 3 years) and sex-matched. Their demographic and clinical characteristics were analyzed to identify the risk factors for CRE colonization using multivariate logistic regression analysis. During the study period, the prevalence of CRE was 2.9% (105/3,657). In the univariate analysis, factors associated with CRE colonization included the use and duration of antibiotic intake; admission to intensive care unit (ICU); and use of enteral feeding tube, urethral Foley catheter, tracheostomy, and central venous catheter. In the multivariate analysis, use and duration of antibiotic intake and admission to ICU persisted as independent factors. CRE should be considered when antibiotics are administered to a stroke patient, especially if the administration period is more than 2 weeks, and if the stroke patient has been admitted to the ICU. This study suggests preventing post-stroke infections and, if possible, reducing ICU admissions and preventing CRE transmission in all stroke patients admitted to the ICU.