Bone Scintigraphy in Poststreptococcal Periostitis With Dysproteinemia.

A 39-year-old man presented with severe bone pain in the tibiae and forearms in the wake of a poststreptococcal sepsis complicated with pneumonia and erysipelas 4 months earlier. Bone scintigraphy was indicative of periostitis of the tibia, ulna, and radius bilaterally, and in combination with the increased inflammatory parameters and dysproteinemia, the diagnosis of Goldbloom syndrome was made. Goldbloom syndrome is an idiopathic periosteal hyperostosis associated with dysproteinemia and elevated inflammatory parameters. Although it has only been described in children/adolescents, this case illustrates that, in the specific clinical and biochemical setting, it should also be considered in adults.

Voriconazole-induced periostitis: a new rheumatic disorder.

Over the past few years, several reports of periostitis affecting patients treated with voriconazole appeared in the literature. As rheumatologists are likely to be called to see such patients, a review of the reported cases was undertaken. A systematic search of Pubmed and Google scholar for case reports, case series and observational studies was undertaken. Twenty-six articles including 23 case reports/case series (total 40 patients), a prospective study and two retrospective studies of 58 cases were included. Age ranged from 3 months to 77 years. Eleven cases (27.5 %) were male and 29 cases (72.5 %) were female. The duration of treatment varied from 6 weeks to 8 years (mean 53.6, SD 77.4 weeks). Most cases presented with diffuse skeletal pain affecting various sites in association with elevated alkaline phosphatase. Periostitis is increasingly reported and should be considered in patients taking voriconazole who present with bone pain and/or alkaline phosphatase elevation.

Fluorosis and periostitis deformans as complications of prolonged voriconazole treatment.

We describe a case of development of painful periostitis deformans in a 39-year-old woman who was receiving long-term voriconazole treatment for Aspergillus infection as a complication of orthotopic liver transplant. Measurement of fluoride levels strongly supports fluorosis to be the mechanism of the voriconazole-induced periostitis deformans and supports the concept that such measurements might be of use in predicting this complication of long-term voriconazole treatment.

Increasing high-sensitive C-reactive protein level predicts peritonitis risk in chronic peritoneal dialysis patients.

BACKGROUND: The aim of this study was to evaluate whether a high baseline level of high-sensitivity C-reactive protein (hs-CRP) or changes in the level predicts the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS: A prospective, cross-sectional, case-control study was conducted in a single hospital-based PD unit. A total of 327 patients were included in the study. Serum hs-CRP was measured annually for 2 years. Patients were divided into 4 groups according to the changes in annual hs-CRP levels (at baseline and at 1 year intervals): group 1 (from <5 mg/L to <5 mg/L, n = 171), group 2 (from <5 mg/L to ≥5 mg/L, n = 45), group 3 (from ≥5 mg/L to <5 mg/L, n = 45), and group 4 (from ≥5 mg/L to ≥5 mg/L, n = 80). Demographics, biochemistry results, PD adequacy indices, and peritonitis risk were compared between the groups. RESULTS: The initial serum albumin level was similar in the 4 groups (p = 0.12). There was a negative linear correlation between the serial albumin change (∆alb) and serial hs-CRP change (∆hs-CRP; r = -0.154, p = 0.005). The hazard ratio (HR) for peritonitis was significantly higher in group 2 (HR = 1, reference) than in group 4 (HR = 0.401, 95% CI 0.209 - 0.769). Group 2 had a greater serum albumin decline rate (∆alb: -3% ± 9%) and hs-CRP elevation rate (∆hs-CRP: 835% ± 1232%) compared to those for the other groups. CONCLUSIONS: A progressive increase in the hs-CRP level was associated with a corresponding decline in the serum albumin level. Progressive rather than persistently high levels of serum hs-CRP predicted peritonitis risk in CAPD patients.

Long bone florid reactive periostitis ossificans: a case in the distal femur mimicking osteosarcoma.

Florid reactive periostitis ossificans is a well-known benign lesion classically described in hands and feet which histopathological features can lead to a misdiagnosis of osteosarcoma. To the best of our knowledge, there is only one previous report of this lesion in a long bone. In this study we report a case of florid reactive periostitis ossificans located in the distal metaphysis of the left femur that histologically mimicked an osteosarcoma and discuss the differential diagnosis between these two entities to warn about a diagnostic pitfall.

Polyarthritis and periostitis induced by Escherichia coli. Lipopolysaccharide injection in young male hamsters.

OBJECTIVE: To describe the clinicopathological manifestations of lipopolysaccharide (LPS) induced arthritis in the hamster and to compare its time of onset, duration, and severity with other forms of experimentally induced arthritis. METHODS: A preparation containing 30 microg LPS from Escherichia coli was injected subcutaneously for 5 to 21 days into young male hamsters (Mesocricetus auratus). Arthritis was quantified by measuring soft tissue swelling of affected joints with calipers. After decalcification, paraffin sections were cut and stained with hematoxylin and eosin, Giemsa, and azan. Acute phase reactant apolipoprotein serum amyloid A (apoSAA) levels were determined by ELISA. RESULTS: Symmetrical polyarthritis developed within 3 days and persisted for 14-21 days, provided the hamsters received daily LPS injections. Most prominent were lesions in the carpal-metacarpal joints of the front legs and in the tarsal-metatarsal joints of the hind legs. Animals in whom LPS injections were discontinued after 4 or 7 days recovered completely. Histological findings of exudative synovitis, periarticular soft tissue swelling, and juxtaarticular periostitis were associated with a sharp rise in serum titers of apoSAA. CONCLUSION: The unusually rapid onset of arthritis and periostitis in this experimental animal model suggests that its systemic manifestations were not mediated by a classical immune response, and may represent an "innate" response of targeted cells within the synovial membrane and periosteum to bacterial cell wall endotoxins.