Tuberculous spondylitis: epidemiologic and clinical study in non-HIV patients from northwest Spain.

OBJECTIVES: To study the epidemiology, clinical features, and outcome of non-human immunodeficiency virus (HIV) patients diagnosed with tuberculous spondylitis (TS) in a well-defined region of northwestern Spain. METHODS: Retrospective chart review of patients older than 14 years of age diagnosed with TS at two contiguous areas between 1986 and 1999. RESULTS: Thirty-seven patients (19 men; mean age 60.3 years) were diagnosed with TS. The average annual incidence rate of TS was 0.55/100,000 population 15 years of age and older. The thoracic and lumbar regions were affected in most cases. The mean duration of symptoms before diagnosis was 28 weeks (range 3-129). Active or healed pulmonary tuberculosis was observed in only 30%. The tuberculin skin test was negative in 24%. The most common findings at the time of diagnosis were back pain and elevated ESR (either 89%). Of note, only 19% had fever. On admission plain radiographs disclosed the presence of spondylitis in 84% of the patients. Computed tomography scan and magnetic resonance imaging yielded conclusive diagnostic data in the cases with normal radiographs, and were very useful in the visualization of abscesses and intraspinal compression. Cultures of material from percutaneous needle aspiration and open bone biopsy were positive for Mycobacterium tuberculosis in 79% and 77% of the cases, respectively. Antituberculous therapy was given to all patients (mean duration of treatment 44 weeks). Surgical procedures were performed in 12 cases, in 7 of them to remove paraspinal and/or epidural abscesses, and in 5 because of neurological complications. Local pain and neurological deficits were the mostfrequent sequelae (16 and 8 cases, respectively). One patient died during the course of treatment due to a co-morbid disease. None of the patients had relapses of tuberculosis. CONCLUSION: TS is a major cause of morbidity. There is a long delay to the diagnosis in most patients. Awareness of its clinical features and early therapy are required to reduce severe complications.

[Acute ischemia of the lower limb in a patient with temporal arteritis and rheumatoid arthritis, carrier of anticardiolipin antibodies]. / Isquemia aguda de miembro inferior en un paciente con arteritis de la temporal y artritis reumatoide, portador de anticuerpos anticardiolipina.

We report a case of Temporal Arteritis, carrier of IgG anticardiolipin antibodies, who presented seronegative polyarthritis with AR criteria after 7 months. Three months later he developed acute ischemia in the right leg, which induced to amputate it. The biopsy showed thrombosis of the femoral arteria, and a dense lymphoplasmocytic infiltrate in its wall. We underline this association (TA-RA) with anticardiolipin antibodies, the exceptional affectation of the femoral arteries in this disease and the probable participation of anticardiolipin antibodies in the genesis of the arterial thrombosis.

[Focal and segmentary necrotizing glomerulonephritis in rheumatoid arthritis. Description of 2 cases]. / Glomerulonefritis necrotizante focal y segmentaria en la artritis reumatoide. Descripción de dos casos.

Two patients diagnosed of seropositive Rheumatoid Arthritis, developed severe renal failure associated in one case to alveolar hemorrhage. The renal histological study showed in both patients Focal and Segmentary Necrotizing Glomerulonephritis, with extracapillary proliferation. There were no evidences of concomitant diseases or nephrotoxic pharmacological therapy in the two patients. The first patient had a positive response to the corticosteroid and immunosuppressive therapy, whereas the second patient developed an irreversible renal failure. We think that this complication, although extremely rare, must be taken into account in all patients with Rheumatoid Arthritis presenting a quick and sudden impairment of his renal function.