Pneumorraquis, espondilitis y meningitis secundarios a cistitis enfisematosa / Pneumorrhachis, spondylitis and meningitis secondary to emphysematous cystitis. Report of one case

We report a 57-year-old woman who presented with low back pain, fever and impairment of consciousness. The patient was admitted to the intensive care unit in Glasgow 8, with neck stiffness, peritoneal irritation, leukocytosis, hyperglycemia requiring insulin and a urine test suspecting an infection. Brain CT was unremarkable, while CT of the abdomen and pelvis evidenced emphysematous cystitis, retropneumoperitoneum and pneumorrhachis. Blood, urine and cerebrospinal fluid cultures were positive to Escherichia coli. She was treated with ceftriaxone, ciprofloxacin and amikacin during one month followed by ciprofloxacin until completing 100 days. The air in the spinal canal and bladder decreased. However she suffered several infectious complications such as multiple paravertebral, epidural and psoas abscesses, L5-S1 spondylitis and a L3 fracture. As an inflammatory complication she developed a bulbar infarction and tetraparesis. She had a good clinical response with medical treatment, partial improvement of the paresis and reduction of epidural abscesses.

Diagnostic clues for spondylitis in acute brucellosis

To determine the diagnostic factors for brucellar spondylitis. This retrospective study included 227 consecutive brucellosis patients admitted to the Infectious Diseases and Clinical Microbiology clinics of Adiyaman State Hospital and Adiyaman 82[nd] Year State Hospital, Adiyaman, Turkey between January 2010 and December 2012. Acute brucellosis was diagnosed by standard tube agglutination test and/or growth of Brucella spp. in appropriately prepared culture media [Bactec]. Brucellar spondylitis was diagnosed and followed-up with contrast-enhanced magnetic resonance imaging. Among the 227 brucellosis patients included, 88 [38.8%] were male, and 139 [61.2%] were female. Brucellar spondylitis was detected in 54 patients [23.7%]. Brucellar spondylitis patients had higher mean age, higher fever, and higher blood culture positivity rate when compared with brucellosis patients [p=0.001, p=0.001, and p=0.001]. Logistical regression analysis determined that male gender [OR: 3.006], older age [OR: 1.025], erythrocyte sedimentation rate [ESR] [OR: 1.067], high fever at the time of admission [OR: 2.550], and positive blood cultures for Brucella spp. [OR: 4.003] values were independently associated with brucellar spondylitis. However, high C-reactive protein [CRP] levels [OR: 0.971] were not found as a risk factor for brucellar spondylitis. The results of this study shows that the risk of developing brucellar spondylitis is high in patients with acute brucellosis, who are at advanced age, who have high fever, that have Brucella spp. growth in their blood culture that has a high ESR value, and who are male

Bone tuberculosis: a case report on child

The authors report a case of a 12-year-old child with a complaint of pain and deformity in the lower thoracic region that had lasted for two years. Clinical, epidemiological and laboratory characteristics associated with images of apparent damage in the T9-T10 and T11-T12 vertebrae taken by radiography of the thoracic spine and nuclear magnetic resonance in addition to the positivity of the molecular test based on the polymerase chain reaction, led to tuberculous spondylitis being diagnosed and specific therapy was started. Culture of vertebral biopsy was positive for Mycobacterium tuberculosis after thirty days.

Frequency and magnetic resonance imaging patterns of tuberculous spondylitis lesions in adults

To find out the frequency and patterns of various lesions in tuberculous spondylitis in adults on magnetic resonance imaging [MRI]. Case series. Radiology Department, Military Hospital [MH] Rawalpindi, from September 2006 to March 2007. Patients with features suggestive of tuberculous spondylitis underwent plain T1-weighted and T2-weighted images and T1-weighted contrast enhanced images in both axial and sagittal sections. The data was analyzed in terms of frequency and patterns of various lesions of tuberculous spondylitis causing abnormal signals in spinal and paraspinal areas. Mean +/- standard deviation were calculated form numerical data using SPSS version 15. Out of 75 patients, 39 were females. The mean age was 42.4 years. Involvement occurred through SV1 vertebral levels. Most common involvement was seen in the thoracic vertebrae [40%] followed by lumbar vertebrae. The most common MRI feature was abnormal signal intensities appearing hypointense on T1W and hyperintense on T2W sequences with heterogeneous enhancement of the vertebral body in all patients. The characteristic findings of spinal tuberculosis included destruction of two adjacent vertebral bodies and opposing end plates, destruction of intervening disc, and occurrence of paravertebral and epidural abscesses. MR imaging of spinal tuberculosis, characteristically showed contiguous involvement of two vertebrae along with the intervening disc, skip lesions, and paraspinal collections and provides critical information about the involvement of spinal cord and the extent of the disease

Surgical Treatment of Thoracic Outlet Syndrome Secondary to Clavicular Malunion

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.

A Case of Postoperative Tuberculous Spondylitis with a Bizarre Course

Postoperative infections following spine surgery are usually attributable to bacterial organisms. Staphylococcus aureus is known to be the most common single pathogen leading to this infection, and the number of infections caused by methicillin-resistant Staphylococcus aureus is increasing. However, there is a paucity of literature addressing postoperative infection with Mycobacterium tuberculosis. We encountered a case of tuberculous spondylitis after spine surgery. A man had fever with low back pain three weeks after posterior interbody fusion with instrumentation for a herniated intervertebral disc at the L4-L5 level. He had been treated with antibiotics for an extended period of time under the impression that he had a bacterial infection, but his symptoms and laboratory data had not improved. Polymerase chain reaction for Mycobacterium tuberculosis turned out to be positive. The patient's symptoms finally improved when he was treated with antituberculosis medication.

Espondilite por brucelose: relato de um caso / Brucellar spondylitis: a case report

Paciente do sexo feminino, 50 anos de idade, branca, com história de dor lombo-sacra com irradiaçäo para os membros inferiores há quatro meses. Os exames de imagem mostravam processo inflamatório envolvendo os corpos vertebrais de L3 e L4 e o disco intervertebral correspondente. Tendo em vista a ausência de antecedentes cirúrgicos, exames negativos para tuberculose e forte antecedente epidemiológico, prosseguiu-se a investigaçäo, com sorologia positiva para brucelose. Os exames de controle, após dois meses de antibioticoterapia específica, mostram a evoluçäo característica das lesöes vertebrais na brucelose

Costo-transversectomy for tuberculous spondylitis

Thirteen cases of tuberculosis of the dorsal spine with paravertebral abscess and weakness of both lower limbs were treated between July 1993 to July 1995. Eight cases were male [62%] and five female [38%]. Age ranged from 11 years to 65 years. Costotransversectomy was selected as the spinal decompression procedure. Ninety two percent of the patients improved and were able to walk within three to nine months of surgery

Espondilitis tuberculosa de ubicación no habitual: a propósito de un caso / Atypical form of spinal tuberculosis

Se presenta una paciente de 41 años con dolor lumbar de 20 meses de evolución, al que se agregó impotencia funcional y parestesia de miembros inferiores. La Tomografía Axial Computada de columna lumbosacra sin y con contraste evidenció compromiso óseo y de partes blandas. El examen directo del material obtenido por punción aspirativa bajo guía Tomografía Computada fue positivo para BAAR. Se reporta un caso de espondilodiscitis tuberculosa de ubicación no habitual, revisión bibliográfica y diagnósticos diferenciales

Radiological changes of bones and joints in brucellosis

Twenty-six patients with radiographic changes of brucella spondylitis and arthritis were studied. The diagnosis was based on clinical and serological tests. Of those 26 patients [12 males,14 females], the following spinal involvement was observed: lumbar [15] patients, dorsal [1] patient, dorsolumbar patient [1] patient, cervical [6] patients. Periphral joint involvement included: Knees [3 patients], hips [2 patients], shoulder [1 patient], unilateral sacroilitis [5 patients], multiple abnormalities [10 patients The main changes were destructive lesions in the vertebral bodies [usually marginal] with characteristic sclerotic reactions around them and proliferative marginal new bone formation; the disc space was usually narrow