ABSTRACT
A 39-year-old Ugandan student is described presenting with general malaise, fever and a pulmonary infiltrate. Open lung biopsy showing infarction and positive ANCA lead to a diagnosis of Wegener's granulomatosis and a treatment with immunosuppressive drugs was instituted. Five weeks after admission, however, sputum cultures turned out to be positive for Mycobacterium tuberculosis. The importance of ANCA-interpretation and the possibility of false positive results is discussed.
Subject(s)
Autoantibodies/analysis , Cytoplasm/immunology , Neutrophils/immunology , Tuberculosis, Pulmonary/diagnosis , Adult , Diagnosis, Differential , Diagnostic Errors , Granulomatosis with Polyangiitis/diagnosis , Humans , Male , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Pulmonary/microbiologyABSTRACT
Two cases of "tropical" pyomyositis or bacterial abscess of striated muscle are presented. In the first patient, a Pakistani, computed tomography gave the clue to the diagnosis. The other patient never lived outside Belgium. His history suggested staphylococcal bacteraemia preceding trauma. Familiarity with the disease considerably reduced the delay in diagnosis and treatment.
Subject(s)
Abscess/diagnostic imaging , Myositis/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Adult , Diagnosis, Differential , Humans , Male , Thigh , Tomography, X-Ray ComputedABSTRACT
A case of emphysematous pyelonephritis with gas formation extending into the renal vein is presented. Diagnostic procedures and aggressive surgical management are discussed.
Subject(s)
Emphysema/diagnosis , Klebsiella Infections/diagnosis , Pyelonephritis/diagnosis , Adult , Diabetes Complications , Emphysema/etiology , Emphysema/surgery , Female , Humans , Klebsiella Infections/etiology , Klebsiella Infections/surgery , Klebsiella pneumoniae , Pyelonephritis/etiology , Pyelonephritis/surgeryABSTRACT
A 45-year-old patient is described presenting with severe axial osteoporosis. The presence of maculopapular skin lesions and the combination of osteolytic and osteoblastic bone lesions led to the tentative diagnosis of systemic mastocytosis. This diagnosis was confirmed by measurement of urinary histamine metabolites and by bone biopsy showing increased numbers of mast cells and fibroblast-like cells. The importance of these diagnostic procedures in this rare cause of osteoporosis is discussed.
Subject(s)
Mastocytosis/complications , Osteoporosis/etiology , Axis, Cervical Vertebra/pathology , Biopsy , Histamine/urine , Humans , Imidazoles/urine , Male , Mastocytosis/diagnosis , Mastocytosis/urine , Methylhistamines/urine , Middle AgedABSTRACT
A 73 year old man presented with an acute anteroseptal myocardial infarction. He became progressively hypotensive without signs of left heart decompensation or major rhythm disturbances. Swan-Ganz catheterisation revealed a pattern of right ventricular infarction and under appropriate treatment the patient recovered remarkably well. The importance of recognition of right ventricular infarction is stressed especially in this case where an anteroseptal myocardial infarction was present without the usual left posterior infarction.
Subject(s)
Heart Septum , Heart Ventricles , Myocardial Infarction/complications , Aged , Echocardiography , Electrocardiography , Hemodynamics , Humans , MaleABSTRACT
A case of liver abscess is analysed in the light of recent data from the literature. The attention is drawn on the increase in frequency of this disease over the last 10 years. The diagnosis is difficult to set on clinical and biological grounds but can be established with certainty by means of scintigraphy and hepatic angiography. Identification of the micro-organism is difficult and impossible in more than half of the cases. Treatment which is essentially surgical, in association with antibiotherapy specific of the anaerobic and gram negative micro-organisms, can reduce total mortality to 10%.
