Spinal aspergillus osteomyelitis in immunocompetent patient

Aspergillus osteomyelitis of the spine has rarely been reported in immunocompetent patients. This report describes a case of aspergillus osteomyelitis in an immunocompetent diabetic patent. A 73-year-old lady developed pulmonary infection with spreading of the infection to the spine [T10-T11] leading to spinal cord compression and paraparesis. Bronchial lavage and needle biopsy isolated aspergillus fumigatus. The patient was treated with amphotericine B and itroconazole without surgical debridement. Six months later, the patient was fully independent and had only minimal gait spasticity. Although rare, aspergillus spondylitis should be included in the differential diagnosis of spondylodiscitis. Its distinction from Pott's disease is difficult but of paramount importance in the therapeutic management

Osteomalacic Myopathy due to celiac disease

Celiac disease is a gluten-sensitive enteropathy characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine. It is well known to be associated with a variety of neurological disorders including epilepsy, myopathy, neuropathy and ataxia. The nature of this association is unclear. Although osteomalacia secondary to vitamin D deficiency is a recognized complication of celiac disease, however, severe osteomalacic myopathy as the only presentation of celiac disease is extremely rare. We present 2 interesting cases of osteomalacic myopathy secondary to celiac disease, which were treated successfully with full recovery. An important and unique observation was the brisk reflexes noticed in both patients. The mechanism behind this phenomenon is not well understood. Work-up for celiac disease is warranted in any young patient that presents with myopathy

Etiology of posterior reversible encephalopathy syndrome [PRES]

To study the causes and risk factors for the development of Posterior Reversible Encephalopathy Syndrome [PRES]. Prospective hospital based study over a period of five years from July 1999 to June2004.Patients and methods: Patients with clinical and neuroimaging features consistent with PRES were included in the study. All patients had detail clinical evaluation on presentation, and recovery from PRES. All had CT and/or MRI brain scan and other hematological and serological investigations to determine the most likely cause of the syndrome. Most patients also underwent follow up neuroimaging to demonstrate resolution of brain lesions. Thirteen patients fulfilled the clinical and radiological features consistent with PRES. Seizures and altered conscious level were most common clinical manifestations. Main radiological feature on CT and/or MRI brain was extensive subcortical edema mainly confined to the posterior parieto-occipital lobes. Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia were main causes of PRES in our study. We also found that this syndrome was more common in females than males. Clinically all patients recovered with control of blood pressure and discontinuation or reduction in dose of the offending drug within 2-7 days. There was almost complete resolution of radiological abnormalities within 2-4 weeks in patients who underwent follow up imaging. Hypertensive encephalopathy, immunosuppressive treatment, renal failure and eclampsia are most common causes of posterior reversible encephalopathy syndrome with a greater predilection for females than males. Multiple factors may be contributory in some patients who develop PRES

Uterine lipoma

Pure lipoma of the uterus is a rare entity and few cases have been reported. They usually develop in postmenopausal women. Clinical symptoms and physical signs are similar to those found in leiomyomas. The histogenesis of these lesions is still unclear. The diagnosis is easily made at the time of surgery or at autopsy, but before this, they may lead to many problems in the differential diagnosis with another uterine tumors. Recent papers suggest the possibility of a preoperative diagnosis made by computed tomography and magnetic resonance imaging. We report a case of a 67-year-old postmenopausal women presented with pelvic pressure and urinary symptoms. Pathological evaluation revealed pure intramural lipoma of the uterus illustrating characteristic morphological and histological findings with no evidence of sarcomata's component