[Pseudomonas aeruginosa osteitis of the spinal process after peridural anesthesia]. / Ostéite de l'apophyse épineuse à Pseudomonas aeruginosa après une anesthésie péridurale.

BACKGROUND: Osteitis of the posterior wall of the spinal canal is an exceptional complication after peridural anesthesia. Prognosis depends on early diagnosis based on clinical signs and imaging data. CASE REPORT: A 73-year-old man was hospitalized for lower back pain and fever of 3 weeks duration after a total hip arthroplasty performed under general anesthesia. Computed tomography and magnetic resonance imaging of the lumbar spine disclosed osteitis of the spinal processes. Local bacteriology sample evidenced Pseudomonas aeruginosa. Outcome was favorable after a 6-month treatment. DISCUSSION: Data in the French and English literature (since 1948) on bone infections following epidural anesthesia have included 5 cases of spondylodiscitis and 1 case of posterior wall osteitis. The diagnosis is suggested by the clinical presentation. Standard x-rays contribute little. Early diagnosis in the infraradiological phase can be obtained with bone scintigraphy. Computed tomography or magnetic resonance imaging are currently highly contributive to diagnosis and follow-up after treatment. Contamination may be direct or via the blood stream or result from an extension of a neighboring infectious focus. Antibiotic therapy and immobilization are indicated. Rigorous application of strict aseptic procedures during lumbar puncture and use of the epidural catheter are crucial for prevention.

[Lymph node tuberculosis in France in non-immunosuppressed adults: current pathology]. / La tuberculose ganglionnaire en France chez l'adulte non immunodéprimé: une pathologie qui reste d'actualité.

PURPOSE: Lymph node tuberculosis is more frequent in Africa or in HIV-infected patients. METHODS: We review results that were obtained in 18 patients with lymph node tuberculosis but without infection by HIV. Eight French native patients (mean age: 69 years) and ten African patients (mean age: 32.5 years) were included into the study. RESULTS: Of the 18 patients, 14 had exclusively hematopoietic localizations, two with medullar involvement and two with either liver or spleen involvement. Normal erythrocyte sedimentation rate was found in two out of 18 cases and normal C-reactive protein levels in seven out of 17 cases. Lymph node biopsy revealed lesions typically associated with tuberculosis in 12 out of 14 patients, two of them had no necrosis. Inflammatory syndrome was inconstant, tuberculin test sometimes negative. A favorable outcome was seen in all cases after 6, 12 or 18 months of treatment, depending on clinical appreciation. CONCLUSION: Tuberculous lymphadenopathy in non-HIV-infected patients may occur without inflammatory syndrome, with sometimes negative tuberculin test and without lymph node necrosis.

[Acute interstitial nephritis and streptococcal infection]. / Néphrite interstitielle aiguë et infection streptococcique.

Two patients with acute renal failure and streptococcal erysipela are reported. In both cases, renal biopsy showed acute interstitial nephritis with a predominantly mononuclear infiltrate. Beta lactam antibiotic without steroid therapy was followed by complete recovery of renal function. It seems likely that some cases of AIN related to infection are erroneously attributed to antibiotic hypersensitivity.

[Systemic form of sarcoid-like necrotizing granulomatosis with ocular, pulmonary and cerebral involvement]. / Forme systémique de granulomatose nécrosante sarcoïdosique avec atteinte oculaire, pulmonaire et cérébrale.

Sarcoid-like necrotizing granulomatosis is an exceptional condition characterized by lesions of epithelioid granulomatosis and signs of vasculitis. It usually involves the lungs and has a favourable prognosis. We report the case of a young woman with a systemic form of the disease which affected not only the lung, but also the eye and the central nervous system. Under corticosteroid therapy the pulmonary lesions and the biological inflammatory syndrome disappeared, but the brain lesions followed a course of their own despite the addition to steroid treatment of an immunosuppressive therapy. This case highlights the superiority of MRI over CT of the brain in the diagnosis and monitoring of brain lesions: CT became normal after corticosteroid therapy was initiated, where as the neurological signs became worse and the brain lesions progressed on MR images.