Brucellosis and sacroiliitis: A differential diagnosis to keep in mind / Sacroiliitis por brucelosis: Un diagnóstico diferencial para tener presente

ABSTRACT Brucellosis is a zoonosis that causes a multi-organ granulomatous infection. It has diverse and non-specific clinic features that can make diagnosis difficult. Medical personnel often do not recognize it early. Delayed treatment is associated with high morbidity and even mortality. Its timely diagnosis requires a high index of suspicion. The case is presented of a 35-year-old male zootechnologist, previously healthy, with a progressive picture of two months of evolution of irradiated low back pain to the left hip, nocturnal diaphoresis, and unintentional weight loss. Elevation of acute phase reactants was documented and magnetic resonance imaging found signs of iliopsoas tendonitis and inflammatory changes in the left sacroiliac joint. The IgG and IgM antibodies using an immunoassay forbrucella were positive. After establishing antibiotic treatment, a marked clinical improvement, with resolution of the inflammatory process was evident.

RESUMEN La brucelosis es una zoonosis que genera una infección granulomatosa multiorgánica. Tiene una clínica diversa e inespecífica que puede hacer difícil el diagnóstico. Con frecuencia, el personal médico no la reconoce de forma temprana. El retraso en el tratamiento se asocia con una gran morbilidad e incluso mortalidad. Su diagnóstico oportuno requiere un alto índice de sospecha. Se presenta el caso de un hombre de 35 arios, zootecnista, previamente sano, con un cuadro progresivo de dos meses de evolución de dolor lumbar irradiado a cadera izquierda, diaforesis nocturna y pérdida no intencional de peso. Se documentó elevación de reactantes de fase aguda y en la resonancia magnética se encontraron signos de tendinitis del psoas y cambios inflamatorios en la articulación sacroilíaca izquierda. Los anticuerpos IgG e IgM por inmunoensayo para Brucella fueron positivos, y luego de instaurar tratamiento antibiótico se evidenció marcada mejoría clínica con resolución del proceso inflamatorio.

Sacroileítis infecciosa secundaria a un absceso del iliopsoas ­ reporte de un caso / Infectious sacroiliitis secondary to an iliopsoas abscess ­ a case report

La sacroileítis infecciosa (SII), también descrita en la literatura como sacroileítis séptica o piógena, es una patología infrecuente, y su diagnóstico constituye un reto debido a su rareza relativa y la diversa presentación clínica, que frecuentemente imita otros trastornos más prevalentes originados en estructuras vecinas. Se requiere un alto índice de sospecha y un examen físico acucioso para un diagnóstico oportuno, mientras que los estudios de laboratorio y de imagen ayudan a confirmar el diagnóstico y dirigir la estrategia de tratamiento apropiada para evitar complicaciones y secuelas a corto y mediano plazos. Presentamos un caso de paciente de género femenino de 36 años, con cuadro clínico de SII izquierda, secundaria a un absceso del músculo iliopsoas, condición que generalmente se presenta como una complicación de la infección. Se realizaron los diagnósticos clínico, imagenológico y Biológico, se inició el tratamiento antibiótico oportuno, y se logró una excelente evolución clínica, sin secuelas

Infectious sacroiliitis (ISI), also described in the literature as septic or pyogenic sacroiliitis, is an infrequent pathology, and its diagnosis constitutes a challenge due to its relative rarity and the diverse clinical presentation, frequently imitating other more prevalent disorders originating in neighboring structures. A high index of suspicion and a thorough physical examination are required in order to establish an opportune diagnosis, while laboratory and imaging studies help confirm the diagnosis and direct the appropriate treatment strategy to avoid complications and sequelae in the short and medium terms. We herein present a case of a female patient aged 36 years, with a clinical picture of left ISI, secondary to an iliopsoas muscle abscess, a condition that usually presents as a complication of the infection. The clinical, imaging and microbiological diagnoses were made, the timely antibiotic treatment was initiated, and an excellent clinical evolution without sequelae was achieved.

Arthrodesis Using Bilateral Dual Iliac Screws with Autologous Iliac Bone Transfer for the Treatment of Pyogenic Sacroiliitis

¿Permiten los entrenamientos de resonancia magnética en espondiloartritis mejorar la performance de los reumatólogos para el reconocimiento de secuencias y lesiones? / Do magnetic resonance training in spondyloarthritis improve the performance of rheumatologists for the recognition of sequences and lesions?

Introducción: La resonancia magnética (RM) es una herramienta diagnóstica fundamental en la espondiloartritis (EspA) axial. Objetivo: Estimar el porcentaje de aciertos en el reconocimiento de lesiones en RM de EspA y conocimientos teóricos, antes y después de realizar una intervención educativa. Estimar si la buena performance en los test se asocia a características individuales de los médicos. Materiales y métodos: Estudio analítico, con intervención activa, se midieron los resultados antes y después de un test con 10 preguntas antes y después del desarrollo de un taller de imágenes de RM en EspA en ciudades distintas de Argentina. Se consideró buena performance a quienes lograron más e 12 puntos entre las dos evaluaciones. Resultados: Se evaluaron en total 106 médicos. Los resultados de los test (total 10 preguntas) antes y después del taller fueron 53% de respuesta correctas y 68% respectivamente (p: 0.000). El 65% de los médicos alcanzaron una buena performance (más de 12 respuesta correctas). Conclusión: El porcentaje de aciertos fue mayor después del taller en forma general, la buena performance no se asoció a ninguna característica especifica de los médicos evaluados.

Introduction: Magnetic resonance imaging (MRI) is a fundamental diagnostic tool in axial spondyloarthritis, it has allowed us, unlike radiography, to diagnose this pathology much earlier. Objective: To estimate the percentage of correct answers in the recognition of SpA MRI lesions and theoretical knowledge, before and after performing an educational intervention. Estimate if the good performance in the tests is associated with individual characteristics of the doctors. Methods: A test was carried out with 10 questions (7 for image recognition and 3 for theoretical knowledge) before and after the development of an MRI image workshop in EspA in diferents cities in Argentina. The correct response number was considered before and after the workshop, and those who achieved more than 12 points between the two evaluations were considered good performance. The following physician characteristics were collected. Results: A total of 106 physicians were evaluated. The results of the tests (total 10 questions) before and after the workshop were 53% and 68% correct, respectively (p:0.000). 65% of the physicians achieved a good performance (more than 12 correct)

Machine learning techniques for computer-aided classification of active inflammatory sacroiliitis in magnetic resonance imaging

Abstract Background: Currently, magnetic resonance imaging (MRI) is used to evaluate active inflammatory sacroiliitis related to axial spondyloarthritis (axSpA). The qualitative and semiquantitative diagnosis performed by expert radiologists and rheumatologists remains subject to significant intrapersonal and interpersonal variation. This encouraged us to use machine-learning methods for this task. Methods: In this retrospective study including 56 sacroiliac joint MRI exams, 24 patients had positive and 32 had negative findings for inflammatory sacroiliitis according to the ASAS group criteria. The dataset was randomly split with ∼ 80% (46 samples, 20 positive and 26 negative) as training and ∼ 20% as external test (10 samples, 4 positive and 6 negative). After manual segmentation of the images by a musculoskeletal radiologist, multiple features were extracted. The classifiers used were the Support Vector Machine, the Multilayer Perceptron (MLP), and the Instance-Based Algorithm, combined with the Relief and Wrapper methods for feature selection. Results: Based on 10-fold cross-validation using the training dataset, the MLP classifier obtained the best performance with sensitivity = 100%, specificity = 95.6% and accuracy = 84.7%, using 6 features selected by the Wrapper method. Using the test dataset (external validation) the same MLP classifier obtained sensitivity = 100%, specificity = 66.7% and accuracy = 80%. Conclusions: Our results show the potential of machine learning methods to identify SIJ subchondral bone marrow edema in axSpA patients and are promising to aid in the detection of active inflammatory sacroiliitis on MRI STIR sequences. Multilayer Perceptron (MLP) achieved the best results.(AU)

Sinal de Faget como manifestação clínica de brucelose. Relato de caso / Faget's sign as a clinical manifestation of brucellosis: Case report

Relata-se o caso de uma paciente do sexo feminino, 32 anos, comerciante, com manifestações sistêmicas de brucelose, como febre diária contínua, sinal de Faget, lombalgia, cervicalgia, náuseas e cefaleia. Quando questionada, a paciente referiu consumo de leite e queijo não pasteurizados de origem bovina. Nos exames laboratoriais, foram evidenciados leucocitose, linfopenia, proteína C-reativa dentro dos parâmetros da normalidade e ausência de transaminasemia, contrapondo achados clássicos da doença. Os exames de imagem mostraram sinais característicos de sacroileíte. O tratamento foi realizado com doxiciclina 100mg via oral a cada 12 horas e estreptomicina 1g via intramuscular diária. O resultado da titulação para brucelose foi positivo. A paciente teve boa resposta ao tratamento, mantendo-se afebril e em bom estado geral até a alta hospitalar, que ocorreu após 14 dias do início da medicação, tendo sido mantido o tratamento ambulatorialmente. (AU)

A case of a 32-year-old female retailer with systemic manifestations of brucellosis, such as prolonged daily fever, Faget's sign, low back and neck pain, nausea and headache. When questioned, the patient reported consumption of unpasteurized milk and cheese of bovine origin. Laboratory tests revealed leukocytosis, lymphopenia, normal levels of C-reactive protein, and absence of transaminasemia, contrasting classic findings of the disease Imaging evaluation showed characteristic signs of sacroiliitis. The treatment was performed with doxycycline 100mg orally every 12 hours, and streptomycin 1g intramuscularly once daily. The serology for brucellosis was positive. The patient showed good response to the treatment, remaining afebrile and in good general condition until hospital discharge, which took place 14 days after starting the medication; she remained on treatment in an outpatient setting. (AU)

Resonancia magnética: su papel actual en las espondiloartritis / Magnetic resonance: its current role in spondyloarthritis

La Resonancia Magnética (RM) se ha convertido en una herramienta diagnóstica fundamental en la EsP axial, ya que se considera la mejor técnica para la detección de lesiones agudas a nivel del esqueleto axial. Su utilización ha sido la mayor contribución, en los últimos años, en la comprensión del curso de esta enfermedad. Esto ha conducido a que, en los nuevos criterios de la Assessment of SpondyloArthritis International Society (ASAS) para la clasificación de EsP de predominio axial, constituya uno de los brazos de ingreso a los criterios (brazo de imágenes). Además, la cuantificación de inflamación en RM, se ha convertido en uno de los parámetros de desenlace en los ensayos clínicos

Magnetic Resonance Imaging (MRI) has become a fundamental diagnostic tool in the axial SpA, since it is considered the best technique for the detection of acute lesions at the axial skeletal level. Its use has been the major contribution, in the last years, in the understanding of the course of this disease. This has led, in the new criteria of the Assessment of SpondyloArthritis International Society (ASAS) for the classification of axial SpA, to constitute one of the entry arms to the criteria. In addition, the quantification of inflammation in MRI has become one of the outcome parameters in clinical trials

Análise da frequência de uveítes em pacientes com espondiloartrites, suas complicações e associação com parâmetros clínicos da doença / Analysis of the frequency of uveitis in spondyloarthritis patients and associations with clinical parameters of the disease

Resumo Objetivo: A uveíte anterior aguda é a principal manifestação extra-articular na espondiloartrite. O objetivo deste estudo foi analisar se a presença da uveíte se associa com diferentes manifestações clínicas, laboratoriais, radiológicas e a terapêutica nos pacientes com espondiloartrite. Métodos: Estudo observacional retrospectivo realizado com 153 pacientes portadores de espondiloartrite atendidos no período de 1997 a 2017 na Grande Florianópolis, Brasil. Foram analisados dados demográficos, laboratoriais, clínicos e do tratamento de pacientes com espondiloartrite em relação a presença ou não de uveíte. Resultados: A uveíte foi encontrada em 26,8% dos pacientes. A presença de complicações foi rara, ocorrendo catarata em somente quatro pacientes e glaucoma em dois deles. Foi observada uma tendência a maior frequência de uveíte anterior aguda no sexo masculino (p=0,06), nos pacientes com história familiar (p=0,19) e HLA-B27 positivos (p=0,14). Pacientes com espondiloartrite e uveíte mais frequentemente usavam anti-TNF (p=0,04) e apresentavam sacroiliite em exames de imagem (p=0,02). Não observou-se associação entre a uveíte e o acometimento cardiovascular (p=0,44), cutâneo (p=0,13) ou gastrointestinal (p=0,10). Conclusão: A uveíte que ocorre em pacientes com espondiloartrite é comum, tem predomínio no sexo masculino e é mais frequente em pacientes com HLA-B27 positivo. O uso de imunobiológicos como o anti-TNF é frequente nos pacientes com uveíte.

Abstract Objective: Acute anterior uveitis (AAU) is the most common extra-articular manifestation of spondyloarthritis. The aim of this study is to analyze if the presence of uveitis is associated with a diferent clinical manifestation, laboratorial, radiological and therapetiuc among spondyloarthritis patients. Methods: This was a observational retrospective study with 153 patients with spondyloarthritis attended in the period from 1997 to 2017 in Florianopolis, Brazil. It was analyzed demografical, laboratorial, clinical and therapeutic data in spondyloarthritis patients with or without uveitis. Results: 26,8% of the patients with spondyloarthritis presented uveitis. The presence of complications was rare, with cataract occurring in only four patients and glaucoma in two of them. A higher frequency of acute anterior uveitis in males (p = 0.06) was observed in patients with a family history (p = 0.19) and HLA-B27 positive (p = 0.14). Patients with spondyloarthritis and uveitis more frequently used anti-TNF (p = 0.04) and presented sacroiliitis on imaging tests (p = 0.02). There was no association between uveitis and cardiovascular (p = 0.44), cutaneous (p = 0.13) or gastrointestinal involvement (p = 0.10). Conclusion: Uveitis in patients with spondylarthritis is common, predominantly in males, and more frequently in HLA-B27 positive patients. The use of immunobiological agents such as anti-TNF is common in patients with uveitis.

Value of Diffusion-weighted Imaging in Evaluating the Activity of Sacroiliitis in Ankylosing Spondylitis / 中国医学科学院学报

Objective To investigate the clinical value of diffusion-weighted imaging (DWI) for evaluating the activity of sacroiliitis in ankylosing spondylitis (AS).Methods Totally 73 AS patients were prospectively enrolled and divided into active group (n=43) and chronic group (n=30) according to Bath ankylosing spondylitis disease activity index (BASDAI) scores and laboratory findings. Conventional magnetic resonance imaging (MRI) and DWI were performed in all subjects. Apparent diffusion coefficient (ADC) values of subchondral lesions in sacroiliac joint were independently measured by two radiologists,and the relative ADC (rADC) values were calculated. ADC and rADC values were compared between active and chronic groups. The efficiencies of ADC and rADC values for differentiating the activity of sacroiliitis were analyzed. In addition,the correlation coefficients of ADC values,rADC values,and BASDAI scores were calculated.Results The ADC and rADC values in the active group were (0.667±0.122)×10 mm /s and (1.715±0.343)×10 mm /s,respectively,which were significantly higher than those of the chronic group [(0.492±0.0651)×10 mm /s and (1.289±0.209)×10 mm /s,respectively)] (P0.81. The correlation coefficients of ADC value and rADC value with BASDAI scores were 0.82 and 0.80,respectively (P<0.0001). The optimal cutoff values of ADC value and rADC value for differentiating AS activity were 0.545×10 mm /s and 1.467×10 mm /s,respectively,The specificity was 81.8% for both indicators,and the sensitivity was 92.0% and 88.0%,respectively.Conclusion DWI is helpful in the quantitative assessment of the activity of sacroiliitis in AS patients.

Sacroileítis tuberculosa: Reporte de un caso y revisión bibliográfica / Sacroiliac joint tuberculosis. Case report and bibliographic review

La tuberculosis es una de las principales causas infecciosas de muerte en el mundo, pese a que existe un tratamiento específico. La sacroileítis representa el 10% de la afectación ósea en la tuberculosis y sigue siendo una entidad de difícil diagnóstico y de tratamiento controvertido. Presentamos el caso de una mujer de 40 años, que comienza con dolor lumbar bajo, asociado a tumoración y fiebre. Luego de una demora inicial se llega al diagnóstico por punción biopsia. Recibe tratamiento médico. El conocimiento de esta enfermedad facilitará el diagnóstico temprano y su tratamiento. Se discuten la presentación clínica, los métodos auxiliares de diagnóstico y el tratamiento, y se presenta una revisión bibliográfica de la enfermedad. Nivel de Evidencia: IV

Tuberculosis is a worldwide known cause of death, even nowadays with specific treatment. Tuberculosis of the sacroiliac joint represents 10% of bone involvement in this disease; diagnosis still remains a challenge, and treatment is controversial. We present a 40-year-old woman with lower back pain, fever and a lower back mass. After an initial delay, diagnosis of tuberculosis of the sacroiliac joint was established by fine-needle aspiration of the joint. Awareness of this particular presentation will facilitate early diagnosis and treatment. Clinical presentation, diagnostic methods and treatment are discussed, and a bibliographic review of this entity is made. Level of Evidence: IV

Disease characteristics of Filipino ankylosing spondylitis patients in Metro Manila rheumatology clinics

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> The study aims to describe the disease characteristics of Filipino patients diagnosed with ankylosing spondylitis (AS) in different rheumatology clinics in Metro Manila, Philippines.</p><p style="text-align: justify;"><strong>METHODS:</strong> The study retrospectively reviewed the records of all Filipino AS patients aged 18 years old and above,diagnosed by the Rome Criteria and seen from January 2000 to May 2012 at the rheumatology outpatient clinic of the Philippine General Hospital and in different rheumatology clinics in Metro Manila. Demographics, joint manifestations, radiographic findings, and medications were described and tabulated. Descriptive statistics included mean and standard deviation for quantitative variables and frequency and percentage for qualitative variables. .</p><p style="text-align: justify;"><strong>RESULTS:</strong> Forty-seven Filipino AS patients were included in the study. The male to female ratio was 46:1. The mean age at diagnosis was 33.2 +/- 10.93 years while the mean disease duration was 7.04 +/- 4.28 years. Seven (14.8%) patients had a family history of AS while twelve (70.6%) tested positive for HLA-B27. The lumbar spine was the most commonly affected site in the majority (80.9%) of subjects. A significant number of participants (70.2%) also had peripheral joint involvement,with the knee being the most common peripheral joint involved (72.7%). In terms of imaging, sacroiliitis was found in the majority (87.5%) of patients. All patients received standard rehabilitation exercises and almost all (97.9%) were on NSAIDs. Nine (19.1%) patients each received opioids and DMARD therapy, while eight (17%) received anti-TNF therapy.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Filipino patients with AS are mostly young males presenting with chronic lumbar pain and HLA-B27 positivity.The data gathered in this study may help local physicians identify AS early in affected patients, giving them access to early intervention and thereby preventing progressive structural and functional deterioration.</p>

Disease characteristics of Filipino ankylosing spondylitis patients in Metro Manila rheumatology clinics

OBJECTIVES: The study aims to describe the disease characteristics of Filipino patients diagnosed with ankylosing spondylitis (AS) in different rheumatology clinics in Metro Manila, Philippines. METHODS: The study retrospectively reviewed the records of all Filipino AS patients aged 18 years old and above,diagnosed by the Rome Criteria and seen from January 2000 to May 2012 at the rheumatology outpatient clinic of the Philippine General Hospital and in different rheumatology clinics in Metro Manila. Demographics, joint manifestations, radiographic findings, and medications were described and tabulated. Descriptive statistics included mean and standard deviation for quantitative variables and frequency and percentage for qualitative variables. . RESULTS: Forty-seven Filipino AS patients were included in the study. The male to female ratio was 46:1. The mean age at diagnosis was 33.2 +/- 10.93 years while the mean disease duration was 7.04 +/- 4.28 years. Seven (14.8%) patients had a family history of AS while twelve (70.6%) tested positive for HLA-B27. The lumbar spine was the most commonly affected site in the majority (80.9%) of subjects. A significant number of participants (70.2%) also had peripheral joint involvement,with the knee being the most common peripheral joint involved (72.7%). In terms of imaging, sacroiliitis was found in the majority (87.5%) of patients. All patients received standard rehabilitation exercises and almost all (97.9%) were on NSAIDs. Nine (19.1%) patients each received opioids and DMARD therapy, while eight (17%) received anti-TNF therapy. CONCLUSION: Filipino patients with AS are mostly young males presenting with chronic lumbar pain and HLA-B27 positivity.The data gathered in this study may help local physicians identify AS early in affected patients, giving them access to early intervention and thereby preventing progressive structural and functional deterioration.

Human brucellosis mimicking axial spondyloarthritis: a challenge for rheumatologists when applying the 2009 ASAS criteria / 华中科技大学学报（医学）（英德文版）

Although the development of the 2009 SpA classification criteria by Assessment of SpondyloArthritis international Society (ASAS) represents an important step towards a better definition of the early disease stage particularly in axial spondyloarthritis (axSpA), the specificity of the criteria has been criticized these days. As the commonest zoonotic infection worldwide, human brucellosis can mimic a large number of diseases, including SpA. This study was performed to determine the frequency of rheumatologic manifestations in patients with brucellosis and the chance of misdiagnosing them as having axSpA in central China. The results showed that clinical manifestations of axSpA could be observed in brucellosis. Over half of patients had back pain, and one fifth of the patients with back pain were less than 45 years old at onset and had the symptom for more than 3 months. Two young males were falsely classified as suffering from axSpA according to the ASAS criteria, and one with MRI proved sacroiliitis was once given Etanercept for treatment. Therefore, differential diagnosis including human brucellosis should always be kept in mind when applying the ASAS criteria, even in traditionally non-endemic areas.

Avaliação computadorizada de sacroiliíte em imagens de ressonância magnética / Computer evaluation of sacroiliitis in magnetic resonance imaging

OBJETIVOS: avaliar e classificar a atividade inflamatória nas articulações sacroilíacas de pacientes com espondiloartrite em imagens de ressonância magnética, utilizando atributos de textura e de histograma de níveis de cinza. MÉTODOS: imagens de 51 pacientes foram avaliadas retrospectivamente e segmentadas manualmente por um radiologista. Trinta e nove atributos de brilho e de textura foram utilizados para caracterizar a presença ou ausência de processo inflamatório. A classificação foi realizada utilizando-se diferentes classificadores e avaliada por um método de validação cruzada com 10-fold. RESULTADOS: uma rede neural multicamadas, utilizando o conjunto total de atributos, alcançou o melhor desempenho no estudo, obtendo 0,915 de área sob a curva ROC, 0,864 de sensibilidade e 0,724 de especificidade. CONCLUSÕES: o processamento computadorizado implementado possui bom potencial como base para o desenvolvimento de uma ferramenta de auxílio ao diagnóstico de processo inflamatório de articulações sacroilíacas de pacientes com espondiloartrites.

GOAL: to evaluate and classify the inflammatory process in sacroiliac joints of patients with spondyloarthritis in magnetic resonance imaging using attributes of texture and gray-level histogram. METHODS: images from 51 patients were retrospectively evaluated and manually segmented by a radiologist. Thirty nine attributes of histogram and texture were used to characterize the presence or absence of the inflammatory process. Classification was performed by several classifiers and evaluated with a 10-fold cross-validation. RESULTS: a multilayer neural network and all extracted attributes obtained highest diagnostic performance in the study with 0.915 of area under the ROC curve, 0.864 of sensitivity and 0.724of specificity. CONCLUSIONS: the implemented computerized processing presents good potential as a starting point for the development of a tool to aid the diagnosis of inflammatory process of sacroiliac joints of patients with spondyloarthritis.

Recurrent macrophage activation syndrome since toddler age in an adolescent boy with HLA B27 positive juvenile ankylosing spondylitis / 소아과

Recurrent macrophage activation syndrome (MAS) is very rare. We present the case of an adolescent boy with human leukocyte antigen (HLA) B27-positive ankylosing spondylitis (AS), who experienced episodes of recurrent MAS since he was a toddler. A 16-year-old boy was admitted because of remittent fever with pancytopenia and splenomegaly after surgical intervention for an intractable perianal abscess. He had been diagnosed with hemophagocytic lymphohistiocytosis (HLH) 4 different times, which was well controlled with intravenous immunoglobulin and steroids since the age of 3. We were unable to identify the cause for the HLH. He remained symptom-free until the development of back pain and right ankle joint pain with swelling at 15 years of age. He was diagnosed with HLA B27-positive AS with bilateral active sacroiliitis. He showed symptom aggravation despite taking naproxen and methotrexate, and the symptoms improved with etanercept. On admission, his laboratory data showed leukopenia with high ferritin and triglyceride levels. Bone marrow biopsy examination showed histiocytic hyperplasia with hemophagocytosis. There was no evidence of infection. He received naproxen alone, and his symptoms and laboratory data improved without any other immunomodulatory medications. Genetic study revealed no primary HLH or inflammasome abnormalities. In this case, underlying autoimmune disease should have been considered as the cause of recurrent MAS in the young patient once primary HLH was excluded.

Platelet Indices Are Associated with Disease Activity Scores and the Severity of Sacroiliitis on Magnetic Resonance Imaging in Axial Spondyloarthritis Patients

OBJECTIVE: To investigate the associations among platelet indices, disease activity scores, and inflammatory markers in axial spondyloarthritis, and to determine the relation between platelet indices and inflammation measured on magnetic resonance imaging (MRI). METHODS: The study included 161 patients who fulfilled Assessment of Spondyloarthritis International Society criteria. Platelet indices such as mean platelet volume (MPV), plateletcrit (PCT), platelet large cell ratio (PLCR), and platelet distribution width (PDW) were measured. Ninety patients underwent sacroiliac (SI) MRI at baseline. Bone marrow edema (BME) and erosion on MRI were scored using the SPondyloArthritis Research Consortium of Canada (SPARCC) method. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and spinal radiologic progression were also assessed. The associations among platelet indices and disease activity scores and inflammatory markers were evaluated. RESULTS: Of the 161 patients, 130 (81%) were male. MPV, PLCR, and PDW were negatively associated with ASDAS and inflammatory marker expression, whereas PCT was positively associated with these parameters. MPV, PLCR, and PDW were negatively associated with BME and erosion scores on SI MRI. However, platelet indices were not associated with the BASDAI and BASFI. The mean erythrocyte sedimentation rate, C-reactive protein, and BME and erosion scores were significantly higher in patients with low MPV. Changes in MPV, PCT, and PDW at baseline and after one year were associated with changes in ASDAS and inflammatory marker expression. CONCLUSION: Platelet indices are associated with ASDAS, inflammatory marker levels, and severity of BME and erosion measured on MRI.

Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy / Seguimento longo em pacientes com sacroileíte submetidos a terapia de radiofrequência ablativa

Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC).Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

A Sacroileíte pode ser responsável por até 40% dos casos de dor lombar crônica. Objetivo Análise da eficácia da denervação por radiofrequência na articulação sacro-ilíaca em seis, doze e dezoito meses.Método Trinta e dois pacientes com diagnóstico de sacroileíte foram incluídos em estudo prospectivo. O prognóstico primário foi avaliado pela escala visual analógico (NRS). O prognóstico secundário foi avaliado pela escala de impressão global de mudança pelo paciente (PGIC).Resultados Melhora a curto prazo da dor foi observada, com redução media na NRS de 7,7 ± 1,8 para 2,8 ± 1,2 após 1 mês e para 3,1 ± 1,9 em 6 meses do procedimento (p < 0,001). Após 12 e 18 meses, o NRS manteve-se 3,4 ± 2,1 e 4,0 ± 2,7, respectivamente.Conclusão A denervação da articulação sacro-ilíaca por radiofrequência pode reduzir significativamente a dor em pacientes com sacroileíte.

Pyogenic Sacroiliitis Caused by Salmonella enterica Serotype Livingstone / 대한내과학회지

Pyogenic sacroiliitis is a rare joint infection, with a challenging diagnosis due to its nonspecific indicators and symptoms. Staphylococcus aureus is the most common causative bacteria of pyogenic sacroiliitis, with Pseudomonas aeruginosa being the most common causative gram-negative bacteria. Interestingly, whereas Salmonella species. is reportedly the second most common cause of this disorder there have been no reported cases of acute sacroiliitis due to Salmonella spp. in Korea, to the best of our knowledge. In this study, we report on the first case in a young Korean adult caused by Salmonella enterica serotype Livingstone, with no underlying disease or predisposing factors.

Enterobacter cloacae Sacroiliitis with Acute Respiratory Distress Syndrome in an Adolescent

Enterobacter cloacae has emerged as an important nosocomial pathogen, but is rarely a cause of sacroiliitis. Herein, we present the first reported case of Enterobacter cloacae sacroiliitis associated with sepsis and acute respiratory distress syndrome (ARDS). A previously healthy 14-year-old boy presented with low-grade fever and pain in the left side of the hip that was aggravated by walking. Pelvic computed tomography (CT) showed normal findings, and the patient received supportive care for transient synovitis with no antibiotics. However, there was no clinical improvement. On the third day of hospitalization, magnetic resonance imaging of the hip revealed findings compatible with sacroiliitis, for which vancomycin and ceftriaxone were administered. The patient suddenly developed high fever with dyspnea. Chest radiography and CT findings and a PaO2/FiO2 ratio <200 mmHg were suggestive of ARDS; the patient subsequently received ventilatory support and low-dose methylprednisolone infusions. Within one week, defervescence occurred, and the patient was able to breathe on his own. Following the timely recognition of, and therapeutic challenge to, ARDS, and after 6 weeks of parenteral antimicrobial therapy, the patient was discharged in good health with no complications.