Assuntos
Articulação Acromioclavicular/microbiologia , Artrite Infecciosa/microbiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus , Articulação Esternoclavicular/microbiologia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/terapia , Terapia Combinada , Drenagem , Humanos , Imagem por Ressonância Magnética Intervencionista , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/terapia , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: Although many patients with IE complain of joint, muscle, and back pain, infections at these sights are rare. Indeed, in patients with back pain and endocarditis, less than 4% actually demonstrate spondylodiscitis. CASE DESCRIPTION: We recently encountered 4 patients with this complication, one each caused by Staphylococcus aureus, Streptococcus bovis, Streptococcus mitis, and Enterococcus faecalis, and wondered whether the nature of the infecting organism determined the development of spondylodiscitis and epidural abscess. In a literature review, 36 patients with endocarditis and spondylodiscitis were identified. Only 9 (25%) were caused by Streptococcus viridans and the remainder by staphylococci, enterococci, and other streptococci. Usually more than 50% of all cases of IE were caused by Streptococcus viridans, although more recent studies would indicate an incidence of about 40%. CONCLUSION: We conclude that spondylodiscitis with epidural abscess is more likely to occur in those patients with endocarditis who are infected by organisms with pyogenic potential.
Assuntos
Discite/microbiologia , Endocardite/microbiologia , Abscesso Epidural/microbiologia , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Discite/diagnóstico , Discite/terapia , Endocardite/diagnóstico , Endocardite/terapia , Enterococcus faecalis , Abscesso Epidural/diagnóstico , Abscesso Epidural/terapia , Feminino , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Masculino , Staphylococcus aureus , Streptococcus bovis , Streptococcus mitisRESUMO
Interferon-alfa (IFN-alpha) is used in patients with various inflammatory and neoplastic disorders. We recently encountered fluorodeoxyglucose (FDG) uptake in generalized lymphadenopathy, splenomegaly, and the marrow in a patient receiving high dose interferon-alpha-2b (IFN-alpha) as adjuvant therapy for the treatment of malignant melanoma. Biopsy of an enlarged hypermetabolic axillary lymph node revealed only a reactive node. Discontinuation of IFN-alpha caused regression of splenomegaly and lymphadenopathy within 3 months.A marrow "hyperstimulation" pattern that can include the spleen is a well-recognized phenomenon on (fluorodeoxyglucose) FDG positron emission tomography/computed tomography (PET/CT) scans in patients receiving chemotherapeutic agents like interferon, though classically due to colony stimulating factors, but does not generally include lymphadenopathy. This case, which likely reflects an interferon-induced pseudolymphoma, highlights the importance of a drug history and clinical correlation for the proper interpretation of FDG PET/CT scans.