Absceso óseo en un paciente joven con artritis reumatoide, a propósito de un caso / Bone abscess in a young patient with rheumatoid arthritis, about a case

Introducción: la artritis reumatoide es una enfermedad inflamatoria sistémica y crónica que se caracteriza fundamentalmente por la presencia de dolor, inflamación, deformidad, discapacidad y disminución de la percepción de calidad de vida relacionada con la salud. El propio mecanismo etiopatogénico de la enfermedad y la acción de los fármacos utilizados en su control generan un estado de inmunosupresión que puede ocasionar la proliferación de bacterias y la aparición posterior de abscesos a distintos niveles. Objetivo: dar a conocer los elementos clínicos, de laboratorio e imagenológicos que permiten llegar al diagnóstico de un absceso óseo en un paciente con artritis reumatoide. Caso clínico: se presenta el caso de un paciente masculino, de 31 años de edad con diagnóstico de artritis reumatoide de 7 años de evolución que acude a consulta con manifestaciones clínicas, de laboratorio e imagenológicos que permiten llegar al diagnóstico de un absceso óseo. Conclusiones: los procesos infecciosos óseos constituyen un factor agravante de la calidad ósea, si los mismos se presentan en pacientes con enfermedades reumáticas como la artritis reumatoide, donde existen distintos niveles de afectación ósea, entonces se compromete más aún la salud y funcionamiento articular(AU)

Introduction: rheumatoid arthritis is a systemic and chronic inflammatory disease characterized mainly by the presence of pain, inflammation, deformity, disability and decreased perception of quality of life related to health. The own etiopathogenic mechanism of the disease and the action of the drugs used in its control generate a state of immunosuppression that can cause the proliferation of bacteria and the subsequent appearance of abscesses at different levels. Objective: to present the clinical, laboratory and imaging elements that allow us to reach the diagnosis of a bone abscess in a patient with rheumatoid arthritis. Clinical case: we present the case of a 31-year-old male patient with a 7-year history of rheumatoid arthritis who presented with clinical, laboratory and imaging findings that allow the diagnosis of a bone abscess. Conclusions: bone infectious processes are an aggravating factor of bone quality, if they occur in patients with rheumatic diseases such as rheumatoid arthritis, where there are different levels of bone involvement, then health and joint function are more compromised(AU)

Discordance between MRI and bone scan findings in a child with acute complicated osteomyelitis: scintigraphic features that contribute to the early diagnosis.

Early diagnosis and prompt treatment of acute osteomyelitis are of paramount importance in children because they can prevent irreversible bone damage. Magnetic resonance imaging (MRI) with its superior spatial resolution and lack of ionizing radiation is routinely preferred over bone scan for this purpose. Increased blood flow, hyperemia and focally increased tracer uptake shown by "three phase" bone scan are the typical scintigraphic findings of acute osteomyelitis. In addition, diffuse uptake along the shaft of long bones and focal "cold" lesions are two special features that may be highly suggestive of infective periostitis, soft tissue sepsis and subperiosteal abscess formation, due to the loose attachment of periosteum to bone during childhood. We present a case of complicated osteomyelitis in a child with inconclusive MRI correctly diagnosed on the basis of these special scintigraphic findings resulting in treatment change from double i.v. Vancomycin--Ceftriaxone scheme to surgical intervention.