De nuevo sobre la artritis por cuerpo extraño / More on arthritis due to a foreign body

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Espondilodiscitis y absceso epidural por Klebsiella pneumoniae / Septic spondilodisitis and epidural abcess by klebsiella pneimoniae

Las artritis y espondilodiscitis infecciosas causadas por Klebsiella pneumoniae son muy poco frecuentes. Describimos el caso de un paciente de 75 años con enfermedad pulmonar obstructiva crónica, que presentó una infección urinaria y una espondilodiscitis lumbar (L4-L5) por el mismo biotipo de Klebsiela pneumoniae, complicada con absceso epidural y absceso del psoas. La evolución con antibioterapia fue favorable y pudo ser dado de alta tras seis semanas de hospitalización (AU)

[Disseminated extrapulmonary tuberculosis with skin, lymph node and bone involvement]. / Tuberculosis extrapulmonar diseminada con afección cutánea, ganglionar y ósea.

Disseminated extrapulmonary tuberculosis is uncommon in no immunocompromised hosts. We described the case of a 68-year-old HIV seronegative man, who presented with a 5 months history of constitutional symptoms, generalized lymphadenopathy, evening fever, osteomyelitis of the left fibula and cutaneous lesions (papules and pustules). There was neither clinical nor radiological evidence of pulmonary involvement. On the basis of bacteriological and pathological findings the diagnosis of disseminated extrapulmonary tuberculous was made.

Tuberculosis extrapulmonar diseminada con afección cutánea, ganglionar y ósea / Disseminated extrapulmonary tuberculosis with generalized lymphadenopathy, osseus and cutaneous lesions

La tuberculosis extrapulmonar diseminada es poco frecuente en pacientes sin compromiso inmunológico. Describimos un paciente de 68 años, sin anticuerpos frente a VIH y sin factores de riesgo conocidos, que presentó un síndrome general de cinco meses de evolución acompañado de poliadenopatías, fiebre vespertina , osteomielitis del peroné izquierdo y lesiones cutáneas (pápulas y pústulas), en quien los estudios microbiológicos e histológicos llevaron al diagnóstico de una tuberculosis extrapulmonar diseminada (AU)

Oligoartritis asimétrica seronegativa, entesitis y dermatopatía psoriásica en un paciente VIH negativo con angiosarcoma de Kaposi / Seronegative asymetric oligoarthritis, enthesopathy and psoriatic dermatopathy in a HIV-negative man with Kaposi's angiosarcoma

Presentamos el caso de un paciente de 40 años, afecto de miopatía ocular, HIV negativo con angiosarcoma de Kaposi, que desarrolló una oligoartritis asimétrica y dermatopatía psoriásica. Durante el seguimiento cumplió criterios para el diagnóstico de lupus eritematoso sistémico (artritis, pleuritis, leucopenia y títulos elevados de anticuerpos antinucleares y de anti-DNA nativo). En nuestro conocimiento, no se había descrito la coexistencia de dichos procesos. Consideramos que esta asociación podría reflejar una compleja interrelación entre factores genéticos y alteraciones inmunológicas (AU)

[Polymyalgia syndrome and atrial myxoma]. / Síndrome polimiálgico y mixoma auricular.

We present a case of polymyalgia-like syndrome in a 62-years-old woman with four month history of severe headache, muscular claudication, asthenia, normochromic, normocytic anaemia and elevation of erytrocyte sedimentation rate. A diagnosis of giant left atrial myxoma was made brought about by thoracoabdominal magnetic resonance. Their surgical exeresis was followed by gradual disappearance of symptoms and normalization of laboratory parameters.

[Asymmetric oligoarthritis in Castleman's disease]. / Oligoartritis asimétrica en la enfermedad de Castleman.

The angiofollicular lymph node hyperplasia (Castleman's disease) is an entity of unknown etiology. Its diagnosis is based on clinical and histological criteria. We present the case of a 20-year-old male patient with asymmetric oligoarthritis and fever which response to nonsteroidal antiinflammatory drugs as onset of abdominal Castleman's disease mixed type.

[Infectious bursitis: study of 40 cases in the pre-patellar and olecranon regions]. / Bursitis infecciosas: estudio de 40 casos de localización prepatelar y olecraneana.

BACKGROUND: Septic bursitis usually affects subcutaneous localized bursae such the prepatellar and elbow bursae. This condition is infrequently reported in the spanish medical literature. The aim of this report was to study patients suffering from septic bursitis with regard to predisposing conditions, the causative agents, therapy and clinical outcome. METHOD: A retrospective study was undertaken in patients with infectious bursitis attended in the Service of Rheumatology of the POVISA Medical Centre (Vigo) and Juan Canalejo Hospital (La Coruña), Spain, from january 1989 to january 1995. The diagnosis of septic bursitis was confirmed with positive bursal fluid cultures in all cases. RESULTS: We recovered forty cases of infectious bursitis (23 olecranon bursitis and 17 prepatellar bursitis). Most patients were male (80%), and patient mean age was 52 years (range: 14-94). The most common predisposing factors to bacterial infection were steroid therapy (15%) and alcoholism (8%), in addition to cutaneous lesions associated with occupational or recreational trauma (55%). Prepatellar septic bursitis was associated with a more aggressive clinical presentation with fever (71% vs 48%), leukocytosis (76% vs 52%), cellulitis (59% vs 48%) and positive blood cultures (25% vs 0%). Staphylococcus aureus was isolated from 87.5% of bursal fluid aspirations, the other etiologic microrganism were Staphylococcus epidermidis (2 cases), Streptococcus agalactiae (2 cases) and Streptococcus pneumoniae (1 case). The majority of patients (80%) required initial intravenous therapy of which average duration was 11 days (range: 5-21 days). Successful resolution of septic bursitis without open surgical drainage was seen in 38 patients (95%) and there ware no functional impairment, serious complications or recurrences. CONCLUSIONS: The majority of patients with septic bursitis suffered systemic and/or local predisposing illness. S. aureus is the commonest pathogen. Prepatellar septic bursitis is associated with a more aggressive clinical presentation and bacteremia. Usually, the prompt and proper antibiotic therapy make innecessary surgical drainage.

[Hand arthropathy of professional origin: milkingman hand]. / Artropatía de las manos de origen profesional: mano del ordeñador.

OBJECTIVE: The aim of this case-control study was to know possible correlates between distinctive pattern of hand arthrosis and length manual milking. PATIENTS AND METHODS: Between January 1990 and January 1996, we retrospectively reviewed the patients with symptomatic arthrosis in whose hands was identified this pattern: degenerative disease of distal interphalangeal joints with radial deviation and flexion of distal phalanges in association to arthrosis involving metacarpophalangeal and interphalangeal joints of the thumb. The first 88 cases of hand arthrosis without this clinical and radiographic pattern make the control group. Patients suffering inflammatory rheumatic diseases were excluded. RESULTS: 35 patients with this special pattern of hand arthrosis were recruited. The majority of patients were women (94.3%) and coming from rural environment (94.3%). 32 patients had performed daily manual milking over a period of 20 years, but in three patients the pattern was not related to this activity (odds ratio = 928: p < 0.001). Symptoms were more frequent in the control-group (57% versus 26%; p < 0.04), in which no characteristic pattern of alignment abnormality was found. CONCLUSION: A typical pattern of hand arthrosis was associated with prolonged manual milking: degenerative disease of metacarpophalangeal and interphalangeal joints of thumb, radial deviation associated with flexion of distal phalanges of second at fourth fingers and arthrosis involving their distal interphalangeal joints, often linked to sight ulnar deviation of middle phalanges.

[Pseudotumor in the forearm caused by focal myositis. A rare form of idiopathic inflammatory myopathy]. / Pseudotumor en antebrazo causado por miositis focal. Una forma inusual de miopatía inflamatoria idiopática.

Focal myositis is a rare form of idiopathic inflammatory myopathy. We describe an additional case of focal myositis in a 54-years-old woman presenting as a painful pseudotumor of the left forearm. Muscle enzymes were normal but generalized electromyographic abnormalities were found. We consider that focal myositis is a heterogeneous clinical syndrome, and the cases showing only focal involvement can be different from those that evolve into polymyositis.

[Septic arthritis caused by Salmonella enteritidis in systemic lupus erythematosus]. / Artritis séptica por Salmonella enteritidis en el lupus eritematoso sistémico.

Systemic Lupus Erythematosus (SLE) is among the chronic diseases thought to predispose patients to severe Salmonella infections. However, arthritis and osteomyelitis due to this microorganisms are more frequently seen in patients with sickle-cell disease than SLE. We report two cases of SLE and osteoarticular infections by Salmonella enteritidis: A 36-years old woman with bilateral knee arthritis associated with femoral osteomyelitis and a 22-years-old woman who presented with left knee arthritis.

[Van Buchem disease. Study of 2 cases and review of the literature]. / Enfermedad de Van Buchem. Estudio de dos casos y revisión de la literatura.

We report two members of one family, a 51-year-old man a 16-year-old son, with enlargement of the jaw, palatine taurus, endosteal sclerosis of the neurocranium and symmetrical diaphyseal cortical thickening. On the basis of those typical findings, the diagnosis of recessive endosteal hyperostosis (Van Buchem's disease) was mode. This unusual hereditary sclerosing bone dysplasia is discussed with respect to the clinical and radiological features as well as its distinction from other sclerosing disorders.