[Coxsackie virus infection associated with myositis and polyarthritis]. / Miositis y poliartritis asociada a infección por virus Coxsackie B.

A wide spectrum of muscle disorders caused by Coxsackie B virus, ranging from acute nonspecific myalgia to rhabdomyolisis have been described. Arthritis in not widely recognised as an either manifestation of Coxsackie virus infection, and only ten patients has been reported previously. A case of polymyositis and polyarthritis associated with primary Coxsackie B infection in a 6-year-old girl is reported. Seroconversion of IgM and IgG antibodies for Coxsackie virus B was observed coinciding with the clinical features: fever, herpangine, polyarthritis, erythematous macular rash, myalgia and muscle weakness with high levels of aldolase and creatine kinase. Electromyographic changes of myositis were found. However, histopathologically biopsied muscle demonstrated a slight inflammatory mononuclear cell infiltrate without necrosis or regeneration of muscle fibres. Polyarthritis and full muscle strength was recovered 8 and 32 weeks after the onset, respectively.

[Pneumococcal spondylodiscitis and pleural effusion. Report of a case and literature review]. / Espondilodiscitis dorsal neumocócica y derrame pleural. Aportación de un caso y revisión de la literatura.

Streptococcus pneumoniae osteomyelitis in adults appears to be a rare event and, apart from isolated case reports, vertebral osteomyelitis due to this pathogen has rarely been reported. We described a immunocompetent 73-year-old woman who was admitted for fever, abdominal and inflammatory back pain. She was diagnosed of T10-T11 spondylodiscitis and right pleural effusion based on computed tomography and magnetic resonance imaging. Streptococcus pneumoniae was isolated from an aspirate of the vertebral foccus. The medical literature for other cases of pneumococcal spondylodiscitis was conducted from 1970 to 2005.

[Prosthetic knee infection caused by Listeria monocytogenes in a woman with rheumatoid arthritis and Waldenström s macroglobulinemia]. / Artritis séptica por Listeria monocytogenes sobre rodilla protésica en una paciente con artritis reumatoide y macroglobulinemia de Waldenström.

Listeria are gram-positive bacilli that can be isolated from soil and in the normal fecal flora of many mammals. It is a uncommon pathogen in the general population, but immunocompromised individuals can develop several focal infections, most notably meningoencephalitis and sepsis. Nevertheless, infectious arthritis caused by Listeria monocytogenes is a exceptional event. We report a new case of prosthetic knee arthritis due to Listeria in a woman with seropositive rheumatoid arthritis and Waldenström s macroglobulinemia receiving prednisone and methotrexate. In addition, we review the literature on listeria joint infections.

[Pyomyositis, sacroiliitis and spondylodiscitis caused by Staphylococcus hominis in a immunocompetent woman]. / Piomiositis, sacroiliitis y espondilodiscitis por Staphylococcus hominis en una mujer sin compromiso inmune.

In absence of risk factors, osteoarticular infections by coagulase-negative staphylococci are very infrequent. We described the case of a immunocompetent 73-year-old-woman that suffered pyomyositis, left sacroiliitis and spondylodiscitis involving the first and second thoracic vertebrae by Staphylococcus hominis. This multifocal infection occurred five-weeks after intramuscular administration of NSAI for treatment of low back pain associated with a herniated disc L4-L5. This is the first know case of a multifocal muscle skeletal infection by Staphylococcus hominis in a patient immunocompetent.

[Synovial chondromatosis. A study of 39 patients]. / Condromatosis sinovial. Estudio de 39 pacientes.

OBJECTIVE: To study the clinical manifestations, use of diagnostic imaging techniques and outcome of patients with synovial chondromatosis in our health area. PATIENTS AND METHODS: POVISA Hospital provides health services to a population of 127,000 inhabitants. The clinical histories of all the patients in this area who were histologically diagnosed with synovial chondromatosis between January 1992 and December 2003 were reviewed. RESULTS: There were 38 cases of joint chondromatosis, all monoarticular, and one case of extra-articular chondromatosis in 20 men and 19 women aged 56.5±12.7 years (mean±SD) at diagnosis (range: 16-79 years). The main joint affected was the knee (15; 39.5%), followed by the hip (8; 21%) and the temporomandibular joint and elbow, both of these in three patients (7.9%). Previous arthropathy was recorded in 18 patients (18/38, 47.4%). Symptom duration prior to diagnosis was 25.4±34 months. The most frequent clinical manifestations were joint pain (100%), restricted movement (77%) and swelling (57%). Plain radiographs were carried out in all patients and suggested the diagnosis in 20 (51.3%). Magnetic resonance imaging findings led to a diagnosis in 12 out of 15 patients in whom this procedure was required (80%). In all patients loose bodies were removed and synovectomy was performed by arthroscopic procedures in six. In 16 patients (42%) total joint replacement was required. The mean postoperative follow-up was 23.7±5.3 months. No cases of chondrosarcoma were identified and the recurrence rate was low (7.9%). CONCLUSIONS: In our setting, almost half (47.4%) of the cases of synovial chondromatosis occurred in a previously damaged joint: the correct diagnosis was delayed by more than 2 years and total arthroplasty was required in 42% of the patients.

[Infectious spondylodiscitis in a health area of Galicia (Spain) from 1983-2003]. / Espondilodiscitis infecciosas en un área sanitaria gallega, 1983-2003.

OBJECTIVE: To study the clinical-epidemiological characteristics of infectious spondylodiscitis (IS) in adults of our health area in the late 20 years. MATERIAL AND METHODS: We performed a retrospective analysis of the medical records of adult patients with a diagnosis of both, tuberculous (TS) and non tuberculous spondylodiscitis (NTS), between January 1983 and December 2003. The diagnosis was made when compatible clinical-radiological picture were present in association with at least two positive blood cultures and/or micro-organism recovery from vertebral samples. Additionally, TS was diagnosed when biopsy showed typical caseating granulomas from vertebral or extra-vertebral lesions. RESULTS: 17 TS and 22 NTS were identified. The mean age was lower in patients with TS than in NTS (43.5 +/- 24.6 vs 52.0 +/- 15.2 years; mean +/- SD). Patients were predominantly males in both, TS (57%) and NTS (82%; p < 0001). The time between the onset of symptoms and diagnosis was longer in TS (16.4 +/- 15.2 weeks) than in NTS (3.9 +/- 3.2 weeks), p= 0.005. Seven (41%) of the 17 patients with TS had active extra-vertebral tuberculosis. A source of infection was presumed in 20 NTS (90%), mainly surgical spinal procedures (9/22.41%). In three TS and four NTS one o more predisposing factors were observed. The patients with NTS presented a higher prevalence of fever (41 vs 24%; p= 0.0003) and leucocytosis (41 vs 12%; p < 0.001), but less neurological impairment (9 vs 21% p= 0,01). None patient with NTS presented mixed infection and Staphylococcus aureus was the main pathogen (14/22.64%) follows by Streptococcus sp (6/22.27%). Klebsiella pneumoniae and Proteus mirabilis were the remain causative agents. Spinal cord decompression and surgical drainage of abscess were performed in five patients (24%) with TS and four patients with NTS (18%), p= 0.0027). Neurological sequels were more common in the patients with TS (24 vs 14%, p= 0.008). The global incidence of IS was 2.2 cases/105 inhabitants/year, which 1.73 cases are NTS. CONCLUSIONS: The IS are a unusual disease what occurs predominantly in male patients. In the last 10 years, a increasing prevalence of NTS was observed, with high contribution (41%) of post-surgical cases. Diagnostic delay is greater in patients with TS and this condition was associated with more neurological sequels.

[Erdheim-Chester disease and Langerhans histiocytosis. A fortuitous association?]. / Enfermedad de Erdheim-Chester e histiocitosis de células de Langerhans. ¿Una asociación fortuita?

Erdheim-Chester disease is an idiopathic systemic histiocytosis hystologically different to Langerhans histiocytosis which is characterized by symmetric sclerotic bone lesions, predominantly affecting the diaphyseal and metaphyseal areas of large bones. It is not classified within malignant histiocytosis, but the clinical course tends to be aggressive with a poor response to different schedules of treatment. In rare cases the association of both entities has been reported: Erdheim-Chester disease and Langerhans histiocytosis. We present a new case with histological data of both histiocytosis whose clinical course included bone and muscle pain, insipidus diabetes, exophthalmos, bilateral symmetrical sclerosing bone lesions and a cerebellar syndrome.

[Spinal epidural involvement as presentation form of non-Hodgkin's lymphoma: report of 6 cases]. / Compromiso epidural espinal como presentación de los linfomas no hodgkinianos: aportación de 6 casos.

Spinal cord compression and radicular involvement are infrequent events in the natural history of non-Hodgkin's lymphoma, which usually are secondary to invasion of spinal extradural space, and rarely are the presenting manifestations of this condition. Thoracic segment is predominantly affected, but any spinal region can be affected. Histologically, the spinal tumour are frequently a high-grade B lymphoma with aggressive behaviour. The aim of this work was to describe six new cases of non-Hodgkin's lymphoma in adults (five woman and one men), presenting with spinal neurological complications. The medical literature about this entity are revised.

The influence of vitamin B2 intake on the activation coefficient of erythrocyte glutation reductase in the elderly.

OBJECTIVE: To evaluate the influence of dietetic vitamin B2 on the activation coefficient of erythrocyte glutation reductase (alpha-EGR) of a group of elderly people. DESIGN: The study subjects were 133, independently-living elderly people, between 65 and 90 years of age. A dietetic study was performed using a 7-day food record. Riboflavin status was measured by determining the alpha-EGR. RESULTS: Some 23.9% of subjects had riboflavin intakes lower than those recommended. At the biochemical level, 9.8% of subjects (7.7% of men and of 10.6% women) showed alpha-EGR>1.2. Those subjects with riboflavin intakes below 90% of those recommended showed significantly higher alpha-EGR levels (1.15+/-0.16), an indication of a poorer riboflavin status at the biochemical level. Those with greater intakes showed lower alpha-EGR values (1.05+/-0.10). Furthermore, the mean consumption of dairy products (an important source of this vitamin) by subjects is insuficiente (341.1+/-159.8 g/day, 2.1+/-1 servings/day). The data show that those with riboflavin intakes below those recommended took 204.7+/-89.4 g/day of milk products (1.3+/-0.5 servings/day) compared to the 384+/-153.1 g/day (2.4+/-1 servings/day) (p<0.001) consumed by those with higher riboflavin intakes. CONCLUSION: Although the mean riboflavin intake is acceptable, there remain some insufficiencies that require attention. It would seem advisable to recommend the elderly increase their intake of milk products. This would be especially important for subjects who take less than two rations per day.

[Peripheral septic arthritis in adults. Epidemiologic study in a Galician health area]. / Artritis sépticas periféricas en adultos. Estudio epidemiológico en un área sanitaria gallega.

BACKGROUND: Both, clinical and biologic manifestations of septic arthritis are long been know, but few studies of its epidemiological aspects are well-documented. Literature concerning epidemiological aspects of septic arthritis remains exceptional in Galician Autonomic Community. OBJECTIVE: The aim of this investigation was to study the etiopathogenesis and epidemiological characteristic of septic arthritis in the adult population from hospital county of Servicio Galego de Saúde (SERGAS). MATERIAL AND METHODS: We conducted a retrospective study of all peripheral septic arthritis registered between 1 January 1995 and 31 December 2000 on adult population of our health district of SERGAS (127.000 inhabitants). The location, etiology, pathogenesis and epidemiological characteristics were obtained from medical records. RESULTS: The case records of 45 patients with 46 septic arthritis (37 native joints and 9 prosthetic joints) were registered. The mean age was 57 years and 24 patients were male. During the study period, the incidence of bacterial arthritis suffered a progressive reduction to 10.2/105 inhabitants (1995) up to 3.1/10(5) (2000) with a median of 7.2/10(5). Ten patients (22%), eight male and two women, had a post-traumatic septic arthritis. Major risk factors were diabetes mellitus (5 patients), rheumatoid arthritis (5 patients) and intravenous drug abuse (3 patients). Staphylococcus aureus was the principal causative agent (28 patients, 62%) and the knee was the most commonly affected joint (41%), followed by the hip (15%) and ankle (15%). CONCLUSIONS: During the past six years, the incidence of adult peripheral septic arthritis in our SERGAS health district has been gradually reduced. Trauma was a important factor in the development of septic arthritis through direct inoculation or through spread from adjacent infectious focus. The major systemic factors predisposing to joint infection were rheumatoid arthritis and diabetes mellitus. In both, native and prosthetic joints, Staphylococcus aureus was the most common isolated pathogen.

[Auto-induced eosinophilic panniculitis: a diagnostic dilemma]. / Paniculitis eosinofílica autoinducida: un desafío diagnóstico.

Eosinophilic panniculitis is characterized by a prominent infiltration of subcutaneous fat with eosinophils. The clinical spectrum of lesions that display pathologic changes of eosinophilic panniculitis is diverse, but nodular lesions are the most common. The factitial eosinophilic panniculitis are exceptional, show a pleomorphic pattern of findings and are associated with personality disorders. Its main challenge is to establish the correct diagnostic. We report an unusual case of factitial nodular febrile panniculitis of the left forearm and proximal arm in an 16 year-old girl. She admitted that the lesions were self-inflicted by autoinjection of several farming products as attempted suicide. We describe the clinical, radiological and histopathological features as well as the differential diagnosis of this type of panniculitis.

[Renal failure secondary to granulomatous interstitial nephritis as initial manifestation of sarcoidosis]. / Insuficiencia renal secundaria a nefritis intersticial granulomatosa como primera manifestación de la sarcoidosis.

Sarcoidosis is a rare cause of renal failure and it has been associated with a wide spectrum of renal manifestations, including granulomatous interstitial nephritis. We present the case of a 48-year old male patient with rapidly progressive renal insufficiency due to sarcoid normocalcemic granulomatous interstitial nephritis who lacked the pulmonary signs of sarcoidosis. Prednisone therapy yielded a favorable outcome with fall in serum creatinine level and resolution of abnormalities of the urinary sediment.