Gonococcal arthritis in a healthy adult. Is it that possible?

A case report is presented of a 50-year-old woman who was seen in Accident and Emergency because of pain in the lumbar area. She was subsequently diagnosed with septic arthritis of the left hip due to being Neisseria gonorrhoeae positive for beta-lactamase. She responded to treatment with ceftriaxone, but later required a total hip replacement.

Presentamos el caso de una mujer de 50 arios, sin antecedentes de importancia, a quien se le diagnosticó inicialmente lumbago e infección de vías urinarias. Por persistencia del dolor y limitación de la movilidad en la cadera izquierda se inicia el estudio de artritis séptica, que fue provocada por Neisseria gonorrhoeae betalactamasa positiva, sensible a tratamiento con ceftriaxona, con posterior deterioro articular, el cual requirió reemplazo total de cadera.

Avaliação do paciente com artrite / Assessment of patients with arthritis

Artrites são manifestações clínicas de uma série de doenças. Sua classificação etiológica é muitas vezes difícil e depende de história clínica e exame físico cuidadosos. Artrite séptica e gota se apresentam mais comumente como monoartrite aguda e quadros reacionais são geralmente poliarticulares. A internação hospitalar é fator de risco para o desenvolvimento tanto de artrites reacionais quanto para crises de gota e artrite séptica. O diagnóstico precoce é muito importante a fim de iniciar o tratamento precocemente, alívio dos sintomas e preservação da funcionalidade articular. A punção do líquido sinoviale sua análise são de fundamental importância diagnóstica nos quadros de monoartrite aguda.

Arthritis are clinical manifestations of plenty of diseases. Its etiological classification is many timesdifficult and depends on careful clinical history and physical examination. Gout and skeptical arthritispresents commonly as acute monoarthritis and reactional arthritis are often polyarticular. Hospitalaradmission is a risk factor to the development of reactional arthritis, crisis of gout and septical arthritis.Early diagnosis is imperative to start early treatment, symptom relief and articular function preservation.Synovial fluid aspiration and its analysis are of critical diagnostic importance in cases of acute monoarthritis.

Síndrome da angústia respiratória aguda na criança: relato de caso / Acute respiratory distress syndrome in a child: case report

Os autores apresentam um caso de Síndrome da Angústia Respiratória Aguda (SARA), numa criança de 5 anos de idade, como fator complicador de um pós-operatório de artrite séptica no quadril. A paciente evoluiu com edema agudo de pulmão não cardiogênico, além de bronco e laringoespasmo, configurando uma insuficiência respiratória aguda grave. O ecocardiograma indicou diminuição do débito cardíaco e aumento do diâmetro ventricular. A radiografia de tórax demonstrou hipotransparência pulmonar, com infiltrado peri-hilar. O diagnóstico foi Síndrome da Angústia Respiratória do Adulto na Criança. O tratamento proposto foi a manutenção das atividades vitais, ventilação mecânica, surfactante pulmonar e agressivo controle da hipertensão pulmonar com óxido nítrico e administração de diurético. Recebeu alta hospitalar com acompanhamento pelo pneumologista pediátrico e alta clínica posterior em bom estado geral.

The authors present a case of Acute Respiratory Distress Syndrome (ARDS) in a five year old child, as a complicating factor after surgery of septic arthritis of the hips. The patient developed acute lung edema, besides bronchial and laryngeal spasm, resulting in respiratory failure. Echocardiography showed reduced cardiac output and increased ventricles. Chest radiography showed low transapency with perihlar infiltrates suggestive of the ARDS. The indicated treatment was ventilatory support, pulmonary surfactant, and aggressive control of the pulmonary hypertension with nitric oxide terapy and diuretics. After hospital discharge, follow-up with a pediatric pulmonologist showed good general health.

Experimentally Induced Pyogenic Arthritis of Rabbit Knees: Comparative Study of MR Imaging and Pathology

PURPOSE: To compare the MR imaging findings of experimentally induced pyogenic arthritis of rabbit knees with the corresponding histopathologic findings. MATERIALS AND METHODS: Infection was induced in 20 rabbit knees by direct intra-articular injection of Staphylococcus aureus. The animals were divided into four groups of five rabbits each, and spin-echo sagittal T1-and T2-weighted images were obtained 3 days, 1 week, 2 weeks, and 4 weeks, respectively, after staphylococcal inoculation. MR-pathologic correlation was performed, with emphasis on intra-and extra-articular soft tissue lesion characteristics. Soft tissue lesion signal intensity (SI) was classified as low, iso, or high on the basis of that of muscle, and high SI was further subdivided into three categories. RESULTS: At T2-weighted imaging, all soft tissue lesions showed high SI. Pathologic examination revealed the presence of inflammatory cell infiltration (n=2), abscess (n=1), granulation tissue (n=3), fibrosis (n=11), edema (n=4), congestion (n=9), and joint fluid (n=11). Except for the abscess, these lesions were irregular in shape and had variable SI (grade 1-3) and at T2WI could not, therefore, be differentiated. In nine kness, extraarticular soft-tissue lesions were demonstrated at T2WI and correlated with infectious soft tissue lesions such as inflammatory cell infiltration, abscess, granulation tissues and fibrosis; and non-infectious reactive soft tissue changes such as edema and congestion. CONCLUSION: In pyogenic arthritis, the MR imaging features of soft tissue lesions varied and were nonspecific, depending on the histopathologic abnormalities observed. Our results indicate that in assessing the extent of pyogenic arthritis with MR imaging, caution is required.