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PubMed1995

[Osteoarticular infections caused by Streptococcus agalactiae. Report of 4 cases].

BACKGROUND: Streptococcus agalactiae (group B streptococcus) is a rare etiology of osteoarticular infection in adults. In a literature review (Medline-Embase plus) up until may 1994, we have found only 51 cases. In most patients, diabetes mellitus, liver disease or long-term steroid therapy were documented. METHODS: Four adult patients with osteoarticular infection due to S. agalactiae from two Galician hospitals were studied from January 1988 to October 1994: prepatellar bursitis (one case), septic monoarthritis (2 cases) and psoas abscess associated to cervical spondylodiscitis and oligoarthritis (left sternoclavicular and left hip joints). RESULTS: In the first patient, a young woman with prepatellar bursitis, a previous local trauma was recorded. The second case, a man with septic arthritis of right knee, had degenerative disease of the knees and a prostatic adenocarcinoma. In the third patient, a diabetic woman with septic arthritis of the left shoulder, vulvovaginitis due to Candida albicans was found. The last patient suffered vertebral osteomyelitis of the cervical spine (C3-C4), arthritis of the left sternoclavicular and hip joints and abscess of the ipsilateral psoas. The evolution was favourable in the four cases. CONCLUSIONS: Although uncommon, osteomyelitis and arthritis caused by group B streptococcus should be considered as opportunistic pathogen in adults with debilitating conditions. Early recognition and prompt institution of adequate therapy can help avoid joint destruction and severe complications.

Adult↗
PubMedDate not supplied

Tuberculous aneurysm of the abdominal aorta: endovascular repair using stent grafts in two cases.

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treatment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was successfully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.

Adult↗
PubMed1993

Diagnosis and treatment of iliopsoas abscess in spinal cord injury patients.

Six patients with spinal cord injury and iliopsoas abscess and other complicating conditions were evaluated with computed tomography (CT), conventional radiography, magnetic resonance imaging (MRI), and radionuclide scans. CT identified the presence of psoas abscess and revealed the depth, extent, and relationship of deep pressure ulcers to deep structures. CT-guided aspiration of the abscess cavities was performed in three patients, with placement of drainage catheters. Concurrent treatment with appropriate antibiotics, followed by staged myocutaneous flap coverage resulted successful outcomes in all patients. A high index of suspicion aids in the early diagnosis of psoas abscess in the SCI patient, as interpretations of physical examination are obscured by the lack of localizing findings. We believe that CT is the diagnostic and therapeutic modality of choice in the management of these complex conditions in the SCI patient, because of its superior ability to detect pathologic changes in the pelvic region and for decreasing the morbidity of the treatment by avoiding open surgery in these often suboptimal surgical candidates.

Adult↗
PubMed2002

Low back pain at presentation in a newly diagnosed diabetic.

Insulin dependent diabetes mellitus predisposes to a range of different and unusual infections, including epidural and psoas abscesses. However, they occur mainly in adults with longstanding diabetes. We report the case of a 12 year old boy who presented with diabetic ketoacidosis and low back pain, and was subsequently diagnosed with both a left psoas abscess and an extensive thoracolumbar spinal epidural abscess measuring 20 cm in length. This case report highlights the need to maintain a high index of suspicion for epidural abscesses in children presenting with fever and localised back pain. Early diagnosis with appropriate imaging and aggressive management can prevent development of permanent neurological damage as was the case in our patient.

Child↗
PubMed1980

CT of inflammatory disease of the psoas muscle.

Computed tomography (CT) findings in eight cases of psoas inflammatory disease are described retrospectively. Because of its exquisite retroperitoneal imaging capabilities, CT proved to be an ideal tool in evaluating suspected disease in this area. Clinically, the deep position of psoas abscesses has made diagnosis problematic. In addition, many radiographic signs of psoas inflammation have provided only indirect evidence, such as displacement of the ureter or alteration of the psoas margin. The organ-specific information available with CT makes detection more efficient and diagnosis more certain. Especially when coupled with percutaneous aspiration biopsy, CT has proved an effective and rapid means of diagnosing and guiding the therapy of psoas abscess.

Abscess↗
PubMed2001

Clinical presentation, radiological findings, and treatment results of coccidioidomycosis involving the spine: report on 23 cases.

OBJECT: This study was conducted to review the presentation and management of patients with coccidioidomycosis involving the spine. METHODS: The authors reviewed 23 cases of spinal coccidioidomycosis treated at their institutions. There were 20 males and three females who ranged in age from 9 to 62 years. Non-Caucasian individuals were disproportionately represented. Spinal disease was the first manifestation of disseminated coccidioidomycosis in 10 cases. Thirteen patients with meningitis, soft-tissue involvement, or pulmonary involvement developed new spinal lesions despite undergoing continued systemic therapy with amphotericin and/or fluconazole. In all patients computerized tomography and magnetic resonance imaging studies demonstrated preferential involvement of the disc spaces, vertebral bodies, and pedicles with extensive paravertebral phlegmons and retropharyngeal, mediastinal, or psoas abscesses. Despite the significant imaging findings, only four patients presented with a significant neurological deficit. Local pain or radiculopathy was the most common complaint. Twenty patients underwent invasive therapy. In five patients with prominent psoas abscesses and disc space disease, drainage was performed after inserting a percutaneous catheter. Progressive bone destruction necessitated debridement and fusion in one of these patients, and two others had poor outcomes after receiving antifungal therapy alone. Initially 15 patients underwent debridement and fusion in which instrumentation (10 cases) or bone graft alone was used (five cases). One patient worsened neurologically after surgery, and another patient required reoperation for a failed fusion and to correct progressive kyphosis. Four of the 23 patients died of complications related to fungemia. Most of the 15 surviving patients have required long-term antifungal therapy for spinal and extraspinal foci. CONCLUSIONS: Spinal coccidioidomycosis can be an aggressive disease process. Systemic antifungal therapy fails to prevent de novo spinal involvement and is usually insufficient treatment for established spinal disease.

Adolescent↗
PubMed2001

[Treatment of primary pyogenic abscess of the psoas: retrospective study of 18 cases].

The primitive abcess of psoas muscle is a rare affection which involves mainly the young. The authors report 18 cases of primitive pyogenic abcess of psoas collected during a period of six years in the urology service of UHC Ibn Rochd Casablanca. The purpose of this review is to discuss the different therapeutic attitudes. The study concerned 11 men and seven women, their mean age was 35 years. The mean delay of evolution was 45 days. The physical exam found a psoitisis (five cases) and a flunk swelling (14 cases). The ultrasound exam showed the collection which was hypoechogenic in seven cases and heterogenous in 11 cases. The CT scan showed an heterogenouse hypodense collection without enhansment in seven cases. The use of antibiotherapy alone (four cases) and percutaneous drainage (four cases) permitted the recovery just respectively in one and two cases. Fifteen patients (83%) were operated through a postero-lateral lumbotomy route without costal resection. The bacteriological exam of the pus found a Staphylococcis aureus (ten cases) and Escherichia coli (two cases). The evolution was favorable in 14 cases; one patient was dead at fifth day post operatively by heart infarction. For the authors, the surgical drainage remains the treatment of choice.

Adolescent↗
PubMed2002

Nocardia farcinica spinal osteomyelitis.

STUDY DESIGN: A case of disseminated Nocardia farcinica infection with spine involvement is reported. OBJECTIVE: To describe the first case of Nocardia farcinica spinal osteomyelitis, and to propose spine instrumentation with debridement and multiple antibiotics for treatment of nocardia spinal osteomyelitis. SUMMARY OF BACKGROUND DATA: Only 11 cases involving Nocardia asteroides spinal osteomyelitis have been reported over the past 40 years. These case reports describe various presentations and treatments of nocardia spinal osteomyelitis. METHODS: A 54-year-old nonambulant, paraparetic man was admitted to the authors' hospital with acutely increased low back pain, fever, and signs of dementia. A disseminated Nocardia farcinica infection including spinal osteomyelitis at T11, T12, L1, L2, and L4; epidural abscess T10-L4, L5-S1 discitis, empyemas, cerebral abscess, and bilateral psoas abscess was noted. RESULTS: Antibiotic therapy, multiple debridements, and posterior instrumentation were performed to palliate the Nocardia farcinica infection. At a recent 3-year follow-up assessment, the patient was independent and ambulant. He had been off antibiotics for 5 months. CONCLUSIONS: Previous case reports of nocardia spinal osteomyelitis describe treatment with antibiotics, debridements, and arthrodesis with autologous bone graft. Prolonged recumbency ensued. In the reported case, a combination of antibiotics, debridements, arthrodesis, and posterior instrumentation for immediate stabilization of the spine resulted in a favorable outcome at 3 years.

Epidural Abscess↗
PubMed1996

Plasma exchange in patients with septic shock including acute renal failure.

In patients with septic shock and multiorgan failure including acute renal failure, the prognosis is poor. This study evaluated the effects of plasma exchange as adjunctive therapy to the conventional treatment in such severely ill patients and compared the results with the expected outcome according to data from other studies. A total of 25 patients (17 men and 8 women, mean age 47, range 15-74 years) were treated by a median of 3 (range 1-10) plasma exchanges, mainly by centrifugation technique. The main replacement fluid was liquid-stored plasma and albumin (in a few cases fresh frozen plasma). About 80% of the patients also received low doses of steroids (hydrocortisone 200-400 mg/day and heparin 1,000-25,000 U/day). Twenty of the patients survived (80%) which was significantly better than was expected by conventional treatment (< 20% survival, p < 0.001). The relative chance to survive was four times greater than expected. Five patients died. The reason of death was cerebral hemorrhagia, brain abscess, myocardial sudden death, relapsing sepsis from multiple hepatic abscesses, and a psoas abscess which was not drained. The patients who survived regained almost total renal function and could leave the hospital with only a few sequelae. The plasma exchange may be a good adjunct to conventional therapy to increase the chance of survival when other treatment is insufficient. The mechanisms by which plasma exchange acts may be by removal of endotoxins derived from microorganisms or tissue necrosis and removal of excessive amounts of cytokines together with a modification of various cascade systems enabled by the products in the plasma from the healthy donors, used for replacement.

Acute Kidney Injury↗