A definite case of spondylodiscitis caused by Streptococcus equisimilis.

To shed light on the role of Streptococcus equisimilis (SE) in the pathogenesis of intervertebral disc infection, we report here a case of lumbar spondylodiscitis in a 37-year-old male caused by SE, with identification of this strain by cultures from L4-L5 lumbar disc biopsy. Intravenous therapy with penicillin and gentamycin combined with immobilization resulted in a rapid and complete recovery. The patient did not have underlying disease and showed no obvious history of exposure to animals. We conclude that SE may be responsible for both septic arthritis and spondylodiscitis.

Multifocal osteogenic sarcoma in Paget's disease.

The most serious complication of Paget's disease is sarcomatous degeneration of pagetic bone. Multifocal sarcomatous degeneration occurs mainly in polyostotic Paget's disease. Multifocal Paget's sarcoma is uncommon and can arise in any site. We report two cases of synchronous multifocal sarcomatous degeneration. The two patients were elderly women (aged 77 and 86 years, respectively) who developed sarcomatous lesions concomitantly, in the first case report in left ilium, left tibia, and first lumbar vertebra and in the second case report in the skull, right ilium, and sacrum. Whether these cases are due to the simultaneous development of several primaries or to metastases from a single primary remains unclear.

Brown tumor of the spine revealing secondary hyperparathyroidism. Report of a case.

Brown tumors are classic skeletal manifestations of hyperparathyroidism usually seen in severe forms with subperiosteal bone resorption. They are exceedingly rare at the spine. We report the case of a woman on hemodialysis who developed two brown tumors, including one at the spine, as the first manifestations of secondary hyperparathyroidism. There were no neurologic manifestations. The clinical and radiologic abnormalities resolved after parathyroidectomy preceded by a bisphosphonate infusion to prevent possible spinal lysis progression during the immediate postoperative period. In addition to the location of one of the brown tumors at the spine, unusual features in this case were the explosive onset of hyperparathyroidism and the absence of detectable subperiosteal resorption. We also suggest that bisphosphonate therapy given before parathyroidectomy may be useful in patients with spinal brown tumors.

[An unusual primary vascular tumor: intimal sarcoma of the pulmonary artery]. / Une tumeur vasculaire primitive particulière: le sarcome intimal de l'artère pulmonaire.

Primary sarcomas of great vessels are rare and involve the aorta, pulmonary artery and inferior vena cava. The pathologic classification of these tumors can be made on the location of the sarcoma in relation to the vessel wall, luminal or mural. Luminal sarcomas are usually intimal sarcoma and mural sarcoma are most frequently leiomyosarcoma. The myofibroblastic or endothelial differentiation of these tumors is still debated. We report a case of intimal sarcoma of the pulmonary artery.

Osteoid osteoma of the acetabulum. Three cases treated by percutaneous resection.

The acetabulum is a rare location for osteoid osteoma. Conventional surgery of such lesions may require either a large bone resection, an arthrotomy, or a hip dislocation. This report describes the technique and results of percutaneous lesion removal using computed tomography guidance in three osteoid osteomas of the acetabulum. Histologic confirmation was obtained in the three cases. The three patients experienced complete pain relief with a mean followup of 36 months.

[Myositis ossificans circumscripta and its variants]. / Myosite ossifiante circonscrite et variantes.

Myositis ossificans circumscripta (MOC) is a benign proliferation of fibrous tissue with large amounts of bone within soft tissues. Its clinical and radiological course is described and the value of CT and MR imaging is emphasized. Differential diagnosis includes soft tissue hematoma, infection or tumor. Florid reactive periostitis of the phalanges, turret exostosis, bizarre periosteal osteochondromatous proliferation in the hand and fibro-osseous pseudotumor of the digits are also described.

Cryocrystalglobulinemia as a cause of systemic vasculopathy and widespread erosive arthropathy.

This report describes the case of woman who was admitted to the hospital for highly destructive axial and peripheral arthropathy in association with acute malignant hypertension and skin purpura. Type I IgGkappa serum cryoglobulinemia was identified and was classified as a monoclonal gammopathy of unknown significance. Cryoglobulin was shown to crystallize in the serum and synovium fluid and was responsible for both granulomatous microcrystalline synovial inflammation and occlusive vasculopathy in the kidneys and skin. Cryocrystalglobulinemia pathogenicity and therapeutic implications are discussed.

[Costa's acrokerato-elastoidosis. Ultrastructural study (author's transl)]. / Acrokérato-élastoidose de costa étude en microscopie électronique.

Acrokerato-elastoidosis described by Costa is characterized by numerous little keratotic points and translucent horny wheals on the dorsal aspect of hands and (or) feets. The ultrastructural study shows lesions of the elastic tissue which is very rarefied with an abnormal structure, but also demonstrates alterations of the fibroblasts that contain dense granules at the periphery of their cytoplasm without elastic extracellular fibers, suggesting a trouble in the secretion or the excretion of the elastic material.

[Costa's acrokerato-elastoidosis. Ultrastructural study (author's transl)]. / Acrokérato-élastoidose de Costa. Etude en microscopie électronique.

Acrokerato-elastoidosis described by Costa is characterized by numerous little keratotic points and translucent horny wheals on the dorsal aspect of hands and (or) feet. The ultrastructural study shows lesions of the elastic tissue which is very rarefied with an abnormal structure, but also demonstrates alterations of the fibroblasts that contain dense granules at the periphery of their cytoplasm without elastic extracellular fibers, suggesting a trouble in the secretion or the excretion of the elastic material.