RESUMEN
A 66-year-old female who had undergone surgery for a herniated disc at the L5-S1 level at another hospital 3 months earlier was admitted with persistent back and leg pain. She was diagnosed with spondylodiscitis at the L5-S1 level by magnetic resonance imaging. A biopsy was performed, and Candida parapsilosis and Enterococcus faecium were isolated from the excised material. We report herein a case of successful treatment of polymicrobial spondylodiscitis in accordance with accurate microbiological diagnosis. Based on this case, we hope to encourage physicians to perform biopsies more aggressively or repeatedly to improve the diagnostic yield.
Asunto(s)
Anciano , Femenino , Humanos , Biopsia , Candida , Coinfección , Diagnóstico , Discitis , Enterococcus faecium , Esperanza , Desplazamiento del Disco Intervertebral , Pierna , Imagen por Resonancia MagnéticaRESUMEN
Prolonged inflammation or immunosuppression may cause lymphoproliferative disorders (LPD). Rheumatoid arthritis (RA) itself causes LPD. The immunosuppressive drug methotrexate (MTX) is used widely to treat RA, and is also related to the development of lymphoma. Although the detailed pathogenesis and association are still controversial, care is needed when managing patients with RA treated with MTX. Many reports indicate that discontinuing MTX can induce the regression of LPD. Here, we describe a case of diffuse large B-cell lymphoma that presented with liver involvement in a 67-year-old woman who had used MTX for RA for 15 years.