ABSTRACT
STUDY DESIGN: Retrospective clinical analysis. PURPOSE: To delineate the clinical presentation of melioidosis in the spine and to create awareness among healthcare professionals, particularly spine surgeons, regarding the diagnosis and treatment of melioidotic spondylitis. OVERVIEW OF LITERATURE: Melioidosis is an emerging disease, particularly in developing countries, associated with a high mortality rate. Its causative pathogen, Burkholderia pseudomallei, has been labeled as a bio-terrorism agent. METHODS: We performed a retrospective analysis of patients who were culture positive for B. pseudomallei. Assessment of patients was performed using clinical, radiological, and blood parameters. Clinical measures included pain, neurological deficit, and return to work. Radiological measures included plain radiography of the spine and magnetic resonance imaging. Blood tests included erythrocyte sedimentation rate and C-reactive protein levels. RESULTS: Four patients having melioidosis with spondylitis were evaluated. All of them had diabetes mellitus; three had multiple abscesses which required incision and drainage. Their clinical spectrum was similar to that of tuberculous spondylitis; all had back pain and radiology revealed infective spondylodiscitis with prevertebral and paravertebral collections with psoas abscess. Three patients underwent ultrasound-guided drainage of the psoas abscess and one had aspiration of the subcutaneous abscess. Bacteriological cultures showed presence of B. pseudomallei, and histopathology showed non-caseating granulomatous inflammation. All patients were treated with intravenous Ceftazidime for 2 weeks, followed by oral bactrim double strength and Doxycycline for 20 weeks. All patients improved with treatment and were healed at follow up. CONCLUSIONS: Melioidosis presents with a clinical spectrum similar to that of tuberculosis. A diagnosis of melioidotic spondylitis should be considered, particularly in patients with diabetes with neutrophilic leukocytosis and clinical-radiological features suggestive of infective spondylodiscitis. Bacteriological culture and histopathology helps in differentiating the two conditions. Health education for healthcare professionals is important for correctly diagnosing this disease.
Subject(s)
Chondrosarcoma, Mesenchymal/diagnosis , Iliac Vein/diagnostic imaging , Iliac Vein/pathology , Vascular Neoplasms/diagnosis , Adult , Chondrosarcoma, Mesenchymal/drug therapy , Diagnosis, Differential , Fatal Outcome , Female , Humans , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Vascular Neoplasms/drug therapyABSTRACT
Primary hyperparathyroidism is a rare cause of acute pancreatitis. Five consecutive patients with acute or recurrent acute pancreatitis and primary hyperparathyroidism were included. All patients had elevated serum calcium on admission and high levels of circulating parathyroid hormone. Both ultrasonography and Sestamibi scan was used to localize parathyroid adenoma. Except for one, all patients underwent parathyroidectomy and postoperative histology was consistent with parathyroid adenoma. One patient died while on treatment. Metabolic causes of acute pancreatitits, though uncommon, are important as early recognition helps management and prevents recurrence.
Subject(s)
Hyperparathyroidism, Primary/complications , Pancreatitis/etiology , Acute Disease , Adolescent , Adult , Biomarkers/blood , Calcium/blood , Diagnostic Imaging , Fatal Outcome , Female , Humans , Hyperparathyroidism, Primary/diagnosis , Hyperparathyroidism, Primary/surgery , Male , Parathyroid Hormone/blood , Parathyroidectomy , Treatment Outcome , Young AdultABSTRACT
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. We report a rare case of rhinosporidiosis, with involvement of the skin, nasal cavity, larynx, oropharynx, and the bronchial tree. The patient underwent bronchoscopic electrocautery excision of the endobronchial lesion with good symptomatic improvement.
