The clinical spectrum of osteoarticular tuberculosis in non-human immunodeficiency virus patients in a defined area of northwestern Spain (1988-1997).

OBJECTIVE: To examine the frequency and clinical manifestations of osteoarticular tuberculosis in non-human immunodeficiency virus (HIV) patients during the past 10 years in a northwestern area of Spain. METHODS: The charts of all patients older than 14 years of age, not HIV-infected, and diagnosed as having osteoarticular tuberculosis at the Xeral-Calde Hospital from 1988 through 1997 were reviewed. All patients were residents of the region of Lugo. The diagnosis of osteoarticular tuberculosis was made on the basis of a positive culture for Mycobacterium tuberculosis from synovial fluid, joint tissue or paravertebral abscess or by histological findings of caseating granulomas in biopsied tissue. RESULTS: Thirty-two HIV-negative patients (20 men and 12 women) were diagnosed with osteoarticular tuberculosis. The average annual incidence rate of osteoarticular tuberculosis in the combined (male and female) non-HIV population > or = 15 years of age was 15.68/million (95% CI: 10.25; 21.11); males 20.02/million (95% CI: 11.25; 28.79); females 11.52/million (95% CI: 5.00; 18.03). The age at the time of diagnosis was 60.8 +/- 17.5 years. Peripheral monoarthritis was observed in 16 of the 32 cases. The knee was the most frequent site of peripheral tuberculous arthritis (31%), but involvement of the non-weight-bearing joints (50%) was also common. Spondylitis involving the lower thoracic and upper lumbar vertebrae (31%) and unilateral sacroiliitis (19%) were less commonly observed. In general, patients with osteoarticular tuberculosis had a long duration of symptoms of the disease prior to the diagnosis (median: 5.5 months). The tuberculin skin test was negative in 3 cases. Chest radiograph was abnormal in only 6 of 32 patients (19%). The ESR (mean +/- SD) at the time of diagnosis was 55.7 +/- 29.0 mm/hr. Computed tomography was very useful in detecting early involvement of the sacroiliac joints and in defining the extent of the abscesses and the severity of the involvement in patients with spondylitis. All patients received chemotherapy for tuberculosis. None of them suffered relapses of tuberculosis. CONCLUSION: Tuberculosis is a major source of osteoarticular complications in northwestern Spain. The prevailing low level of clinical suspicion may explain the long delay to the diagnosis in most patients. A greater awareness of the possibility of this severe complication, especially in the elderly people or in high-risk populations, would be advisable.

[Neuro-Behçet: a follow-up of 4 cases treated with chlorambucil]. / Neuro-Behçet: estudio evolutivo de cuatro casos tratados con clorambucil.

Four patients diagnosed with Behçet's disease developing neurologic manifestation are described. Central nervous system findings were observed in three of them and peripheral neuropathy in ther other patient. All the patients were treated with chlorambucil, 0.1-0.2 mg/kg/day as initial dose. Three of them ended the immunosuppressive therapy after a period of treatment between 12-18 months. None of the four patients suffered neurologic relapses once that the therapy with chlorambucil was started. In a similar way to other authors, we think that treatment with chlorambucil in neuro-Behçet's disease may be useful to reduce morbility related to neurologic relapses.

[Seronegative systemic lupus erythematosus and autoimmune thyroiditis]. / Lupus eritematoso sistémico seronegativo y tiroiditis autoimmune.

The association of systemic lupus erythematosus (SLE) and autoimmune thyroiditis has been previously described. We report a woman with negative antinuclear antibodies (ANA) and criteria for the diagnosis of SLE. The patient was also diagnosed with autoimmune thyroiditis. We review the clinical characteristics and the association of both entities. We also remark in this case the association of autoimmune thyroiditis with seronegative SLE.

Pyomyositis and septic arthritis from Fusobacterium nucleatum in a nonimmunocompromised adult.

We describe a case of pyomyositis of the quadriceps associated with septic arthritis of the knee that developed after Fusobacterium nucleatum septicemia in a healthy man. The primary foci was presumed to be the oral cavity. Pyomyositis from Fusobacterium nucleatum is uncommon, and to our knowledge its association with septic arthritis has not been described.

[Common variable immunodeficiency and polyarthritis: a case report]. / Inmunodeficiencia común variable y poliartritis: descripción de un caso.

We describe a man with common variable immunodeficiency and polyarthritis. He had suffered several infections, including septic arthritis. For this reason we commenced treatment with antibiotics without obtaining a good response. Three weeks' later, and after knowing that the results of all the cultures were negative, we discontinued the antibiotic therapy and started treatment with indomethacin. A dramatic response was rapidly observed. We feel that an arthritis in a patient with a history of previous infections should alert us to the diagnostic possibility of primary antibody deficiency.

[Comparative study of von Willebrand factor in patients with temporal arteritis]. / Estudio comparativo de factor von Willebrand en pacientes con arteritis de la temporal.

Giant cell arteritis, temporal arteritis (TA), is a vasculitis which affects large and medium-sized vessels. The von Willebrand factor (vWF) is synthesized by endothelial cells and megakaryocytes. Increased amounts of vWF are released into plasma in response to an endothelial damage. vWF levels were studied by Electro-Immunodiffusion in 16 patients with TA (8 of them with a positive biopsy) and their values were compared with 5 patients with Polymyalgia Rheumatica (PMR) and 32 controls. We found higher amount of vWF in global TA, biopsy-positive TA, biopsy-negative TA, and PMR than in controls. There were no relationship between vWF amounts in plasma and clinical findings nor the laboratory parameters. We feel that although in our study vWF might be of some help as an alternative to the biopsy in those patients with high suspicion of TA, the results of other authors raise doubt about the usefulness of the determination of vWF in TA.

[Reactive arthritis and infestation by Giardia lamblia]. / Artritis reactiva e infestación por Giardia lamblia.

The association between reactive arthritis and Giardia lamblia infestation, although it has been previously described, is not very common. We present a 32 year-old woman who had oligo-arthritis and erythema nodosum after Giardia lamblia infestation. We think that a Giardiasis should be more frequently considered in patients with arthritis after an episode of diarrhea.