ABSTRACT
We describe the case of a 44-years-old female patient with a panarteritis nodosa preceded by a rapid progressive bilateral deafness after an acute otitis media. Once on treatment with steroids and cyclophosphamide, she developed a disseminated intravascular coagulation, with a fatal evolution not justifiable by a different cause apart from her main disease.
Subject(s)
Disseminated Intravascular Coagulation/etiology , Hearing Loss, Bilateral/etiology , Polyarteritis Nodosa/complications , Acute Disease , Adult , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/pathology , Fatal Outcome , Female , Hearing Loss, Bilateral/diagnosis , Hearing Loss, Bilateral/pathology , Humans , Otitis Media/complications , Otitis Media/diagnosis , Otitis Media/pathology , Polyarteritis Nodosa/diagnosis , Polyarteritis Nodosa/pathologyABSTRACT
Presentamos el caso de una paciente de 44 años con una panarteritis nodosa que vino precedida de una sordera bilateral de rápida instauración tras otitis media. Al iniciarse tratamiento con esteroides y ciclofosfamida, desarrolló un cuadro de CID de evolución fatal no justificable por otra causa diferente a su enfermedad de base (AU)
Subject(s)
Adult , Female , Humans , Acute Disease , Disseminated Intravascular Coagulation/diagnosis , Fatal Outcome , Hearing Loss, Bilateral/diagnosis , Otitis Media/complications , Otitis Media/diagnosis , Otitis Media/pathology , Polyarteritis Nodosa , Disseminated Intravascular Coagulation/etiology , Disseminated Intravascular Coagulation/pathology , Hearing Loss, Bilateral/etiology , Hearing Loss, Bilateral/pathology , Polyarteritis Nodosa/complications , Polyarteritis Nodosa/diagnosis , Polyarteritis Nodosa/pathologyABSTRACT
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.