Use of NaF and FDG PET/CT Scan for the Assessment of Charcot Joint in Charcot-Marie-Tooth Disease: All That Glitters is Gold?

Increasingly Charcot neuroarthropathy (CN) is being recognized in patients with Charcot-Marie-Tooth (CMT) disease. In this report, we describe a case of CN in a CMT patient, adding to the very scarce literature describing this association. We additionally report his unique evaluation with fluorodeoxyglucose (FDG) and sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) scanning, the study of which is limited in CN despite its promising role. A 54-year-old known case of CMT, presented with left foot pain, and swelling for 4 months. Weakness and sensory deficits as a result of CMT were evident in both lower and upper limbs. His x-ray was suggestive of CN. Both FDG and NaF PET/CT scanning demonstrated increased tracer uptake in the first tarsometatarsal joint (TMTJ), in keeping with CN. Recognition of the association of CMT with CN is of vital importance as early diagnosis relies on high clinical suspicion. Characterizing risk factors of CN in CMT patients is still under study. Moreover, there is lack of data evaluating the role of PET/CT in CN and specifically in the context of CMT.

More than what meets the eye in COVID-19 critical illness: A case report of bilateral femoral neuropathy due to psoas hematomas.

Bilateral femoral neuropathy is rare, especially that caused by bilateral compressive iliopsoas, psoas, or iliacus muscle hematomas. We present a case of bilateral femoral neuropathy due to spontaneous psoas hematomas developed during COVID-19 critical illness. A 41-year-old patient developed COVID-19 pneumonia, and his condition deteriorated rapidly. A decrease in the hemoglobin level prompted imaging studies during his intensive care unit (ICU) stay. Bilateral psoas hematomas were identified as the source of bleeding. Thereafter, the patient complained of weakness in both upper and lower limbs and numbness in the lower limb. He was considered to have critical illness neuropathy and was referred to rehabilitation. Electrodiagnostic testing suggested bilateral femoral neuropathy because of compression due to hematomas developed during the course of his ICU stay. The consequences of iliopsoas hematomas occurring in the critically ill can be catastrophic, ranging from hemorrhagic shock to severe weakness, highlighting the importance of recognizing this entity.

Obstructive sleep apnoea triggering autonomic dysreflexia: Isn't it time for sleep studies to be routine in SCI?

Autonomic dysreflexia is a known complication after spinal cord injury. It is defined as a reflexive increase in blood pressure as a result of a painful or irritating stimulus below the level of the lesion. Although commonly caused by stimuli from the bladder, other rare triggers are still being described. Herein, we present a case with autonomic dysreflexia triggered by obstructive sleep apnoea. A 43-year-old smoker suffered a spinal cord injury after a road traffic accident secondary to multiple cervical spine vertebrae fractures. He presented to our rehabilitation centre 6 months post-injury as a case of complete spinal cord injury with C4 neurological level. Autonomic dysfunction in the form of autonomic dysreflexia was occurring on a daily basis. After exclusion of known inciting factors, it was noticed that early morning episodes of autonomic dysreflexia were persistent. He was also reporting daytime fatigue and sleepiness and multiple night-time awakenings. Therefore, work up for sleep apnoea was done. A diagnosis of moderate obstructive sleep apnoea was made. With continuous positive airway pressure treatment, his daily early morning episodes of autonomic dysreflexia settled. This case illustrates the importance of the pattern of blood pressure elevation to pinpoint specific triggers of autonomic dysreflexia.

Coxiella burnetii Endocarditis in a Patient with Systemic Lupus Erythematosus: A Case Report of a Diagnostic Challenge.

BACKGROUND There is a close association between Q fever and autoimmune disease, with some case reports in the literature of Q fever presenting as systemic lupus erythematosus (SLE) and others documenting their coexistence. However, making the correct diagnosis remains challenging and Q fever often is overlooked. Therefore, it is essential to review such a rare presentation to help in accurate diagnosis in future cases. This report is of a case of endocarditis due to Coxiella burnetii in a patient with Q fever and a history of SLE. CASE REPORT We report the case of a 43-year-old man with a history of SLE and rheumatic heart disease, status post-valve replacement. The patient initially presented with an acute kidney injury in the setting of a history of full-house lupus membranous nephropathy, which was diagnosed on kidney biopsy. The patient had been on immunosuppressive therapy for 2 years. Shortly after he was admitted, echocardiography was ordered because the patient had progressive dyspnea, revealing infective endocarditis involving multiple valves. He underwent valve repair surgery and was placed on an extended course of antibiotic therapy. His symptoms gradually resolved, with normalization of his immunological markers. The patient's immunosuppressive regimen was eventually discontinued. He remains on lifelong antibiotic suppression therapy. CONCLUSIONS This case highlights the importance of awareness of infectious causes of endocarditis in patients with underlying autoimmune diseases such as SLE. This rare case of C burnetii endocarditis may have been associated with underlying valvular SLE.

Interferon-Gamma and Interleukin-1Beta Enhance the Secretion of Brain-Derived Neurotrophic Factor and Promotes the Survival of Cortical Neurons in Brain Injury.

Neuro-inflammation is associated with the production of cytokines, which influence neuronal and glial functions. Although the proinflammatory cytokines interferon-γ (IFN-γ) and interleukin-1Beta (IL-1ß) are thought to be the major mediators of neuro-inflammation, their role in brain injury remains ill-defined. The objective of this study was to examine the effect of IFN-γ and IL-1ß on survival of cortical neurons in stab wound injury in mice. A stab wound injury was made in the cortex of male BALB/c mice. Injured mice (I) were divide into IFN-γ and IL-1ß treatment experiments. Mice in I + IFN-γ group were treated with IFN-γ (ip, 10 µg/kg/day) for 1, 3 and 7 days and mice in I + IL-1ß group were treated with 5 IP injection of IL-1ß (0.5 µg /12 h). Appropriate control mice were maintained for comparison. Immunostaining of frozen brain sections for astrocytes (GFAP), microglia (Iba-1) and Fluoro-Jade B staining for degenerating neurons were used. Western blotting and ELISA for brain-derived neurotrophic factor (BDNF) were done on the tissues isolated from the injured sites. Results showed a significant increase in the number of both astrocytes and microglia in I + IFN-γ and I + IL-1ß groups. There were no significant changes in the number of astrocytes or microglia in noninjury groups (NI) treated with IFN-γ or IL-1ß. The number of degenerating neurons significantly decreased in I + IFN-γ and I + IL-1ß groups. GFAP and BDNF levels were significantly increased in I + IFN-γ and I + IL-1ß groups. Interferon-γ and IL-1ß induce astrogliosis, microgliosis, enhance the secretion of BDNF, one of the many neurotrophic factors after brain injury, and promote the survival of cortical neurons in stab wound brain injury.

Osseous Metaplasia of the Cervix: A Rare Transformation Can Mimic a Tumor-Literature Review.

BACKGROUND: The transformation of nonosseous soft tissue into bone is known as osseous metaplasia (OM). This condition most commonly affects the musculoskeletal and central nervous systems and it is a well-known phenomenon in different soft tissue organs. Rarely, OM can affect the uterus, which can extend into the cervix. OM affecting the cervix alone is a more rare condition that has multiple different clinical presentations. The presentation can be similar to that of a tumor in extremely rare cases. CASE SUMMARY: A 23-year-old nulligravida was complaining of irregular vaginal bleeding for one-month duration. Speculum examination revealed a foul-smelling bloody purulent discharge, tender cervix, and a brownish growth located at the posterior cervical lip. A punch biopsy of the growth was performed. Histological examination of the tissue revealed multiple bone fragments with necrosis and an inflammatory exudate. Because of the unusual findings, a repeat biopsy was performed. The biopsy yielded the same findings, which confirmed the diagnosis of osseous metaplasia of the cervix. CONCLUSION: Although osseous metaplasia is a known phenomenon in different soft tissues, it is extremely rare in the uterine cervix and can mimic malignancy. Therefore, clinicians should be aware of it.