Proline-serine-threonine phosphatase interacting protein 1-associated autoinflammatory diseases / 中华实用儿科临床杂志

In addition to the pyogenic arthritis, pyoderma gangrenosum and acne(PAPA) syndrome, autoinflammatory diseases caused by mutations in the proline-serine-threonine phosphatase interacting protein 1 (PSTPIP1) gene also include a group of clinical syndromes such as PSTPIP1-associated myeloid-related proteinemia inflammatory(PAMI) and pyoderma gangrenosum, acne, and hidradenitis suppurativa(PASH) syndrome.In this paper, the expanded spectrum and clinical characteristics of PSTPIP1 related autoinflammatory diseases were reviewed, so as to deepen clinicians′ understanding of this disease, facilitate early diagnosis, and finally improve the prognosis of patients.

Pyoderma gangrenosum, acne, pyogenic arthritis, and suppurative hidradenitis syndrome: a case study / 中华皮肤科杂志

A 22-year-old male patient visited the Department of Dermatology of the First Affiliated I Iospital of Zbengzhou University on October 31,2016 due to dark red papules,nodules,pustules and cysts on the face,neck,back and in the axillary and inguinal regions for 6 years,and multiple dark purple plaques and ulcers on bilateral lower limbs for 1 year.Six years ago,the patient was diagnosed with acne in other hospital,and no treatment was given.One year ago,multiple purple plaques occurred on the bilateral lower limbs,which then ruptured and progressed into ulcers with diameters of 1-12 cm.On May 9,2002,the patient visited the Department of Pediatric Medicine of the First Affiliated Hospital of Zhengzhou University due to the left knee joint swelling and pain for half a year.Laboratory examination showed negative rheumatoid factor,and smear examination of the left knee joint effusions revealed that there were neutrophils and a small amount of lymphocytes and monocytes in the joint effusions,and no abnormal cells were observed.Then,the patient was diagnosed with pyogenic arthritis of the left knee.Physical examination at admission showed poor general condition,walking difficulty,slightly increased blood pressure of 142/92 mmHg (1 mmHg =0.133 kPa),multiple purple plaques on the bilateral lower limbs with central ulcer formation.Histopathological examination of ulcer margin on the lower limbs showed ulceration,intercellular edema and infiltrating neutrophils in the epidermis,and edema,focal erythrocyte extravasation,diffuse infiltration of neutrophils,lymphocytes and histiocytes in the superficial and middle dermis.Clinical manifestations and pathological features confirmed a diagnosis of pyoderma gangrenosum.There were extensive inflammatory papules,pustules,abscesses and cysts on the face,neck,waist and back,and a small amount of dark red nodules on the axillary and inguinal regions,which were consistent with cystic acne and hidradenitis suppurativa.As PSTPIP1 gene sequencing showed,no mutations were found in exon fragments,while compound heterozygous mutations c.36 + 68 G ＞ A,c.137 + 47 G ＞ C and c.562 + 114 C ＞ G her were found in intron fragments.Among 100 healthy controls,45 carried the same mutations.So,these mutation sites were considered to be polymorphic sites,and the pathogenicity of these mutations was still unclear.Finally,the patient was diagnosed with PAPASH syndrome.The patient was treated with methylprednisolone,cefminox,isotretinoin and thalidomide,and the lesions were markedly improved after 2 weeks.Now the patient was still followed up.

Pyogenic Arthritis of the Metacarpophalangeal Joint Treated with External Fixation in Adolescent

When hand injuries caused by human bite are overlooked and they can progress to pyogenic arthritis. Pyogenic arthritis is difficult to treat and can make severe sequelae in the joints. We report a case of pyogenic arthritis of the hand that occurred after human bite injury in adolescent treated with wide debridement and external fixator. Our literature searches revealed that the use of external fixator is good treatment option for the treatment of pyogenic arthritis of the hand.

Osteomyelitis Resulting from Chronic Septic Olecranon Bursitis: Report of Two Cases

We reported the two cases of olecranon osteomyelitis secondary to the iatrogenic chronic relapsing septic olecranon bursitis. Infection was well eradicated by excision of the infected bursa and curettage of the eroded olecranon under the coverage of antibiotic therapy.

Osteomyelitis Resulting from Chronic Septic Olecranon Bursitis: Report of Two Cases

We reported the two cases of olecranon osteomyelitis secondary to the iatrogenic chronic relapsing septic olecranon bursitis. Infection was well eradicated by excision of the infected bursa and curettage of the eroded olecranon under the coverage of antibiotic therapy.

Acute Phase of Sero-negative Rheumatoid Arthritis Misdiagnosed as Pyogenic Arthritis: A Case Report / 대한고관절학회지

In cases of sero-negative rheumatoid arthritis (RA), no abnormal findings are observed on blood tests and its clinical course is favorable, compared to sero-positive RA. In the acute phase of sero-negative RA, infiltration of neutrophils may be the only pathologic finding on frozen section biopsy. Thus, it might be misdiagnosed as pyogenic arthritis. We report on a case of acute sero-negative RA misdiagnosed as pyogenic arthritis during hip surgery with review of the literature.

Pyogenic Arthritis of the Facet Joint with Concurrent Epidural and Paraspinal Abscess: A Case Report

Pyogenic arthritis of lumber spinal facet joints is an extremely rare condition. There are only 40 reported cases worldwide. Most cases were associated with history of paravertebral injection, which was not found in our patient. At the time of hospital admission, he had no abnormal magnetic resonance image findings. Two weeks later, he developed pyogenic facet joint arthritis associated with paravertebral and epidural abscess. This report is the first to describe delayed presentation of pyogenic arthritis associated with paravertebral abscess and epidural infection.

The Surgical Treatment of Pyogenic and Tubercular Infection in the Sternoclavicular Joint: Case Report

PURPOSE: Here we report clinical results for surgical treatment of 2 cases of pyogenic arthritis and 1 case of tubercular arthritis, which only rarely develops in the sternoclavicular joint. MATERIALS AND METHODS: From September 2003 to September 2008, we did early marginal resection and thorough debridement of osteomyelitis of the sternum and distal clavicle in 3 patients and evaluated clinical results after short-term follow up. RESULTS: All 3 patients were satisfied with their clinical results and none had any recurrences according to follow up X-rays and laboratory datas. The follow up MRI showed bone edema in the distal clavicle and proximal sternum and a little fluid retention around the sternoclavicular joint. CONCLUSION: Even though diagnosis of these diseases are made earlier, infection of the adjacent bone and osteomyelitis could already have developed. We did early marginal resection and thorough debridement of osteomyelitis of the sternum and distal clavicle and achieved satisfactory results.

Arthroscopic Management for Septic Arthritis of the Hip Joint in Adults: A Report of Four Cases / 대한정형외과학회잡지

Treatment of pyogenic arthritis in hip joints in adults usually required debridement through early arthrotomy. However, domestically arthroscopic management is not widely performed. Recent development of operation techniques and equipments helped to improve the value of arthroscopic approach and its diagnostic value and therapeutic usefulness. We report the clinical results from the 4 cases of pyogenic arthitis of hip joint in adults treating with arthroscopic irrigation and debridement.

Pyogenic Infection of Deep Joint after Major Burn Injury / 대한정형외과학회잡지

PURPOSE: To report the clinical findings and the results of treatment on hematogenous pyogenic arthritis after major burn injury. MATERIALS AND METHODS: A retrospective analysis was made of 11, 797 major burn injury patients from January 1996 to June 2004. Severity of burn by involved body surface area, time of diagnosis, and laboratory findings were analyzed. Direct spread of infection from injured skin to superficial joint was excluded. RESULTS: Hematogenous infection was complicated in 26 joints of 22 patients (0.19% of overall cases). The mean age was 43.6 years, and mean follow-up was 46 months. The body surface area of burn injury was averaged 34.7%. The common involved area was hip in 10 patients, spine and shoulder in five patients, respectively. From the time of injury, average interval to development of symptom was 4.1 weeks, and to establish the diagnosis was 6.3 weeks. The most common isolated pathogen was Methicillin-resistant Staphylococcus aureus. A total of 22 joints underwent surgical treatment. The clinical results of the patients were poor in 72% due to recurrent infection and persistent pain. CONCLUSION: The results of this study suggest that major burn injury may be an important risk factor of hematogenous pyogenic arthritis. Careful clinical suspicion should be important for early diagnosis and treatment.

Epidural Abscess and Pyogenic Arthritis of Knee Joint in One Family after Epidural Injection

A mother-in-law and a daughter-in-law suffered chronic low back pain and they were injected epidural steroid on same day. Eleven days after injection, the daughter-in-law showed weakness of right lower extremity and lost filling sensation of bladder. Radiologic findings of Magnetic Resonance Imaging for lumbar spine revealed epidural abscess encompassing from L1 to sacral spine. After emergency surgical procedure and antibiotics therapy, the symptoms and the signs disappeared. Seven days after injection, the mother-in-law was diagnosed as pyogenic arthritis of right knee joint and then epidural abscess. Although the surgical procedure for right knee joint and antibiotics therapy were done, the epidural abscess didn't disappear. Moreover, surgical procedure for the epidural abscess couldn't be done due to septic condition, which was the cause of death. We report two cases of epidural abscess showing the importance of early management and serious end result. Prevention of these complication through extreme caution is needed.

Pyogenic Arthritis of the Shoulder Associated with Brachial Plexus Palsy: A Case Report / 대한정형외과학회잡지

Pyogenic arthritis of the shoulder joint is rare in adults and true paralysis associated with pyogenic arthritis is reported more rarely. We describe a case brachial plexus palsy associated with pyogenic arthritis of the glenohumeral joint. Weakness of upper extremity associated with pyogenic arthritis of shoulder is common and usually overlooked but differentiation from true paralysis of brachial plexus with electromyelogram is needed.

Growth Changes of Lower Extremities after Pyogenic or Tuberculous Knee Joints in Children / 대한정형외과학회잡지

It is well-known that the infection of bone and joints could produce the shortening by destroying the articuiar cartilage and growth plate, or the lengthening hy increased hlood circulation to the epiphyseal and metaphyseal regions of long bone. Since 1985, we have treated total l7 cases of children s pyogenic or tuberculous children s knee with early arthrotomy and continuous irrigation etc. and followed their long hone growth for average 53 months after surgical intervention. Five patients (group I ) were early treated within 2 weeks and twelve patients(group 3 ) were delayed to treat their knees for more than 2 weeks of symptom development. Total 11 patients out of 17 cases(64.7%) (2 cases of group 1 pyogenic arthritis, and 1 case of group l and 8 cases of group II tuberculous arthritis) revealed growth acceleration. Femoral lengthening was much more greater than that of tibial growth, and the size of patella, distal femoral and proximal tibial epiphysis which were measured by computerized digitizer were also significantly larger than that of opposite knee. The total limb length was increased hy average 7mm in 6 months, l4mm in 1 year and 3mm in 2 years after operation. These results suggest the pyogenic and tuberculous arthritis in children s knee should he treated as early as possible after symptoms developed, and followed them to trace their limh inequality for at least 2 years after surgery. That means the early arthrotomy for tuberculous knee or even in pyogenic arthritis can preserve normal articular cartilage and can also prevent the early epiphyseal closure hy infection. and can get the limh lengthening by increased blood circulation around the knee joint.

Pyogenic Arthritis in Renal Transplant Recipients / 대한정형외과학회잡지

Acute pyogenic arthritis in renal transplant patient is one of the serious problem resulting in significant morbidity and mortality. The purpose of this paper is to analyze seven patients in whom acute pyogenic arthritis developed following renal transplantation. Pyogenic arthritis developed in seven (0.7%) out of 958 renal transplant patients whose transplanted kidney functioned well for more than two years. The age of the patients ranged from 37 to 65 years with a mean of 48 years. All patients were male. Pyogenic arthritis developed between the period of one and 12 years (mean: 4.5+/-4.2 years) following transplantation. Causative organisms were Staphylococcus aureus (three), E. coli (two), Salmonella (one) and Acinetobacter bananii (one). Involved joints were four knees, one hip, one elbow and one finger. Two patients improved on a conservative regimen of bed rest and antibiotics and five patients required open drainage. However, pyogenic arthritis recurred in three years, four years and seven years after renal transplant in one patient. Looking at the probable risk factors of age, sex, immunosuppresants, diabetics and acute graft rejection, diabetics and older age (over 40 years old) are highly associated with post renal transplant pyogenic arthritis.

Acute pyogenic arthritis of hip in neonate and infant

No abstract available.

Multifocal Pyogenic Arthritis on four Joints: A Case Roport / 대한정형외과학회잡지

Multifocal pyogenic arthritis more than four joints is very rare and considered to be related with some conditions such as immune deficiency, alcoholism, diabetes mellitus, steroid abuse, septicemia and gonococcal infection. In early stage, it is important to differentiate from acute rheumatic fever or acute rheumatic polyarthritis. Authors report a case of multifocal pyogenic arthritis on four joints simultaneously with good result.

A Clinical Study of Septic Arthritis in Children / 대한정형외과학회잡지

After developement of antimicrobial chemotherapy, morbidity and mortality from pyogenic arthritis has been reduced dramatically, but still this disease has remained as a serious and lifethreatening infectious disease of childhood or late sequelae in surviving patients. For the period of 7 years from January 1973 to December 1979, fifty nine children who were treated as septic arthritis at Severance Hospital were studied retrospectively and the results are summerized as follows. 1. Among the 59 cases, 32 cases (54.25%) were male and 27 cases (45.8%) were female. The most prevalent age was 4 to 10 years (40%). 2. Lag period to treatment in most cases was 5 days, and the most prevalent signs on admission was pain around the involved joint. 3. The most commonly affected joint was the hip joint (42.4%). The other affected sites in order of frequency were the knee, ankle and shoulder joint. 4. The underlying causes were composed of infectious focus in 18 cases, minor trauma in 6 cases, iatrogenic reason in 4 cases and unknown in 31 cases. 5. In laboratory findings, the numbers of W.B.C. and E.S.R. were increased in 66.1%, and roentgenologic studies revealed normal in 67.7%, soft tissue swelling in 21% and joint space widening in 9.7%. 6. Causative micro-organism was isolated in 41 cases: Staphylococcus aureus in 34 cases. B-hemolytic streptococcus in 3, Pseudomonas aeroginosa in 2, Enterobacter species in 2. 7. Staphylococcus aureus was highly sensitive to Cephalothin (88.2%) and Methycillin (85.3%), but was highly resistant to Penicillin (88.2%). 8, Four cases were treated non-surgically and 55 cases surgically with arthrotomy-drainage and arthrotomy-continuous irrigation. The results were satisfactory in 83% and unsatisfactory in 17%. 9. The complications were found in 14 cases: recurrence in 4, joint stiffness in 3, dislocation in 2 and sepsis in 1 case. In conclusion, a better result was obtained in cases with early diagnosis and surgical treatment with proper antibiotics.