ABSTRACT
The patient was a 32-year-old man with a previous history of bronchial asthma. He was admitted with chief complaints of dyspnea and skin rash associated with itching of the palms and soles of the feet, which began 2 weeks earlier. Because of the presence of cardiac failure and increase in the peripheral blood eosinophil count, eosinophilic myocarditis (EM) was suspected. His blood pressure gradually decreased and the patient went into cardiogenic shock. Therefore, endomyocardial biopsy was performed and was immediately followed by corticosteroid therapy and intra-aortic balloon pump (IABP) placement. With the findings of eosinophil infiltration associated with myocardial interstitial edema on endomyocardial biopsy, EM was diagnosed. In this case, early therapeutic intervention led to resolution of shock resolved and improvement of the peripheral blood eosinophilia and cardiac function; the patient was discharged 33 days after the onset of symptoms. EM is a rare cardiomyopathy in which myocardial eosinophil infiltration is seen. Although it has been perceived as having a mild clinical course, this report described a severe case of EM associated with cardiogenic shock, which improved as a result of early diagnosis and therapeutic intervention.
Subject(s)
Eosinophilia/complications , Myocarditis/complications , Shock, Cardiogenic/etiology , Adult , Biopsy , Early Diagnosis , Eosinophilia/diagnosis , Eosinophilia/pathology , Eosinophilia/therapy , Humans , Intra-Aortic Balloon Pumping , Male , Methylprednisolone/administration & dosage , Myocarditis/diagnosis , Myocarditis/pathology , Myocarditis/therapy , Myocardium/pathology , Prednisone/administration & dosage , Pulse Therapy, Drug , Severity of Illness Index , Shock, Cardiogenic/therapy , Treatment OutcomeABSTRACT
PURPOSE: To retrospectively describe the feasibility and efficacy of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction with a combination of two interventional radiological techniques-CT-guided bone biopsy and abscess drainage. MATERIALS AND METHODS: Three patients with pyogenic spondylodiscitis at the lumbosacral junction were enrolled in this study between July 2013 and December 2015. The procedure of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction was as follows: the sacrum at S1 pedicle was penetrated with an 11-gauge (G) bone biopsy needle to create a path for an 8-French (F) pigtail drainage catheter. The bone biopsy needle was withdrawn, and an 18-G needle was inserted into the intervertebral space of the lumbosacral junction. Then, a 0.038-inch guidewire was inserted into the intervertebral space. Finally, the 8-F pigtail drainage catheter was inserted over the guidewire until its tip reached the intervertebral space. All patients received six-week antibiotics treatment. RESULTS: Successful placement of the drainage catheter was achieved for each patient without procedural complications. The duration of drainage was 17-33 days. For two patients, specific organisms were isolated; thus, definitive medical therapy was possible. All patients responded well to the treatment. CONCLUSIONS: CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction is feasible and can be effective with a combination of two interventional techniques-CT fluoroscopy-guided bone biopsy and abscess drainage.
Subject(s)
Discitis/therapy , Drainage/methods , Radiography, Interventional/methods , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Feasibility Studies , Female , Humans , Lumbosacral Region , Male , Middle Aged , Retrospective StudiesABSTRACT
A 77-year-old man suffering from prolonged fever of unknown origin and bilateral leg edema was referred to our hospital. On physical examination, he had fever, general fatigue, bilateral lower leg edema, and muscle weakness of the right upper extremity and left lower extremity. Neurological examination indicated motor and sensory disturbance. Electromyography revealed mononeuritis multiplex and myopathy. A biopsy of the left biceps muscle indicated necrotizing vasculitis with fibrinoid necrosis. Considering all the data together, he was diagnosed as having polyarteritis nodosa (PAN) and concurrent active cytomegalovirus (CMV) infection. His symptoms improved promptly on treatment with 50 mg of prednisolone. This case emphasizes the importance of CMV infection as one of possible etiologies of PAN and reports a therapeutic strategy for this syndrome.
