Prevotella bivia Septic Arthritis in an Immunocompetent Adult: A Case Report and Review of Literature.

Septic arthritis is a medical emergency that requires prompt diagnosis to prevent long-term intra-articular complications. Prevotella bivia is an anaerobic gram-negative rod which has been infrequently reported to cause septic arthritis. We present a 49-year-old female that presented with spontaneous left knee pain and swelling without history of insult to the knee. She was initially misdiagnosed with patellar tendinitis and gout but later underwent joint aspiration due to worsening symptoms, which demonstrated 60 800/µL nucleated cells with a polymorphonuclear burden consistent with septic arthritis. Arthroscopy with irrigation and drainage was subsequently performed, and the patient was started on empiric antibiotics while awaiting cultures. Cultures grew Prevotella bivia, and antibiotics were deescalated to ertapenem alone followed by oral metronidazole. Prevotella species as a source of septic arthritis is rare, and its occurrence in a patient without known insult to the knee is even more uncommon. It is essential that it is recognized to treat appropriately and prevent long-term loss of function in the joint.

Spinal cord stimulator for the treatment of central neuropathic pain secondary to cervical syringomyelia: illustrative case.

BACKGROUND: Central neuropathic pain (CNP) of the cervical and/or thoracic spinal cord has many etiologies, both natural and iatrogenic. Frequently, CNP is medically refractory and requires surgical treatment to modulate the perception of pain. Spinal cord stimulation is a modality commonly used in adults to treat this type of refractory pain; however, it is rarely used in the pediatric population. OBSERVATIONS: The authors reported a case involving a common pediatric condition, Chiari malformation type I with syrinx, that led to a debilitating complex regional pain syndrome. The associated life-altering pain was successfully alleviated following placement of a spinal cord stimulator. LESSONS: CNP, or the syndromic manifestations of the pain (complex regional pain syndrome), can alter an individual's life in dramatic ways. Spinal cord stimulator placement in carefully selected pediatric patients should be considered in these difficult pain treatment paradigms.

Timing of Restarting Anticoagulation and Antiplatelet Therapies After Traumatic Subdural Hematoma-A Single Institution Experience.

BACKGROUND: There is a paucity of information regarding the optimal timing of restarting antiplatelet therapy (APT) and anticoagulation therapy (ACT) after traumatic subdural hematoma (tSDH). Therefore, we sought to report our experience at a single level 1 trauma center with regard to restarting APT and/or ACT after tSDH. METHODS: A total of 456 consecutive records were reviewed for unplanned hematoma evacuation within 90 days of discharge and thrombotic/thromboembolic events before restarting APT and/or ACT. RESULTS: There was no difference in unplanned hematoma evacuation rate in patients not receiving APT or ACT (control) compared with those necessitating APT and/or ACT (6.4% control, 6.9% APT alone, 5.8% ACT alone, 5.4% APT and ACT). There was an increase in post-tSDH thrombosis/thromboembolism in patients needing to restart ACT (1.9% APT alone, P = 0.53 vs. control; 5.8% ACT alone, P = 0.04 vs. control; 16% APT and ACT; P < 0.001 vs. control). Subgroup analysis revealed that patients with coronary artery disease necessitating APT and patients with atrial fibrillation necessitating ACT had higher thrombosis/thromboembolism rates compared with controls (1.0% control vs. 6.1% coronary artery disease, P = 0.02; 1.0% control vs. 10.1% atrial fibrillation, P < 0.001). The median restart time of ACT was approximately 1 month after trauma; APT was restarted 2-4 weeks after trauma depending on clinical indication. CONCLUSIONS: Patients requiring reinitiation of APT and/or ACT after tSDH were at elevated risk of thrombotic/thromboembolic events but not unplanned hematoma evacuation. Therefore, patients should be followed closely until APT and/or ACT are restarted, and consideration for earlier reinitiation of blood thinners should be given on a case-by-case basis.