RESUMO
Transarterial chemoembolization (TACE) is one of the most effective therapies for unresectable hepatocelluar carcinoma or metastatic hypervascular tumors. Abscess occurring in the other organs beside the liver after TACE is a complication that often occurs, sometimes potentially fatal. We report a case of spinal epidural abscess occurred after liver abscess complicated by TACE in a patient with metastatic neuroendocrine tumors to the liver. A 67-year-old female underwent TACE first for the metastatic lesions to liver, with a history of pancreatoduodenectomy for the primary pancreatic neuroendocrine tumor. Four days after TACE, sudden high fever occurred, and liver abscess was found on abdominal CT. Two days later, back pain and radiating pain to the right leg occurred, and lumbar spine MRI showed spinal epidural abscess. After intravenous antibiotics for 8 weeks and partial laminectomy, the patient recovered and was discharged without complications.
Assuntos
Idoso , Feminino , Humanos , Antibacterianos/uso terapêutico , Carcinoma Hepatocelular/secundário , Quimioembolização Terapêutica/efeitos adversos , Abscesso Epidural/etiologia , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Laminectomia , Abscesso Hepático/etiologia , Neoplasias Hepáticas/secundário , Vértebras Lombares/microbiologia , Imageamento por Ressonância Magnética , Tumores Neuroendócrinos/patologia , Pancreaticoduodenectomia , Tomografia Computadorizada por Raios XRESUMO
Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Aspergilose/diagnóstico , Aspergillus/isolamento & purificação , Transplante Ósseo , Vértebras Cervicais/microbiologia , Hospedeiro Imunocomprometido , Transplante de Fígado , Vértebras Lombares/microbiologia , Imageamento por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico , Doenças Raras , Espondilite/microbiologia , Vértebras Torácicas/microbiologiaRESUMO
A tuberculose é uma das principais doenças infecciosas de acometimento mundial com 3,9 milhões de casos notificados no mundo, em 2002. A forma esquelética pode corresponder a 3 por cento do número total de casos, sendo 50 por cento devido à tuberculose vertebral. O abscesso de psoas é uma entidade clínica rara com aproximadamente 12 casos relatados por ano na literatura médica e tem no Mycobacterium tuberculosis, um dos seus agentes etiológicos. O objetivo deste trabalho é relatar dois casos de tuberculose vertebral associada a abscesso de psoas atendidos em nosso serviço, bem como uma revisão da literatura.
Assuntos
Adulto , Feminino , Humanos , Masculino , Vértebras Lombares/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Abscesso do Psoas/microbiologia , Tuberculose da Coluna Vertebral/complicações , Antituberculosos/uso terapêutico , Terapia Combinada , Ensaio de Imunoadsorção Enzimática , Vértebras Lombares/cirurgia , Imageamento por Ressonância Magnética , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/cirurgia , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/terapiaRESUMO
Spinal epidural abscess (SEA) is a rare infectious disorder that often has delayed diagnosis and is associated with significant morbidity and mortality rates. We present a case of an AIDS patient with a SEA due to Mycobacterium tuberculosis. This type of SEA in AIDS patients is characterized by localized spinal pain and prolonged fever. Magnetic resonance imaging is the method of choice in the diagnostic process. Early diagnosis, followed by specific therapy (surgical decompression combined with antituberculous drugs), is necessary to improve the prognosis of these kinds of patients.
Assuntos
Adulto , Humanos , Masculino , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Abscesso Epidural/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose da Coluna Vertebral/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/terapia , Antituberculosos/uso terapêutico , Terapia Combinada , Descompressão Cirúrgica , Abscesso Epidural/diagnóstico , Abscesso Epidural/terapia , Vértebras Lombares/microbiologia , Imageamento por Ressonância Magnética , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/terapiaRESUMO
Candida spondylodiscitis associatd with epidural abscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapy and developed systemic Candida infection, which was complicated by Candida spondylodiscitis and epidural abscess
Candida spondylodiscitis associatd with epiduralabscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapyand developed systemic Candida infection, which was complicated by Candida spondylodiscitis and epiduralabscess
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Epidural/microbiologia , Candidíase , Discite/microbiologia , Vértebras Lombares/microbiologia , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/cirurgia , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Discite/tratamento farmacológico , Discite/cirurgia , Espectroscopia de Ressonância Magnética , Osteomielite/complicações , Vértebras Lombares/efeitos dos fármacos , Vértebras Lombares/cirurgiaRESUMO
BACKGROUND: Spondylodiscitis is a rare but prolonged inflammation of two adjacent vertebral bodies and the disk in between. AIM: To report the clinical features of a series of patients with spondylodiscitis. MATERIAL AND METHODS: A retrospective analysis of medical records of patients with spondylitis, identified between 1989 and 2002. RESULTS: A total of 25 cases were identified, 15 female, aged 49.8 years as a mean. Their mean evolution before admission was 4.3 months. Main complaints were back or radicular pain. Mild anemia was present in most patients. Mean erythrocyte sedimentation rate and C reactive protein values were 66 mm/h and 60 mg/L, respectively. Forty four percent of patients had neurological complications. Vertebral computed tomography and scintigraphic studies were done in 72 per cent of patients, but magnetic resonance imaging was done only in 4 (16 per cent). In 18 patients, a tissue sample for pathological and microbiological analysis, was obtained by imaging guiding or surgically. Tuberculosis, diagnosed on pathology, was the leading cause of spondylitis in nine cases (36 per cent), followed by Staphylococcus aureus infection in five (20 per cent). Other agents found were E coli and group D Streptococcus (one each). Age, symptoms, evolution time and different laboratory parameters did not differ between patients with tuberculosis and patients with other causes. A microbiological cause was not established in 36 per cent of cases. Most patients evolved satisfactorily and recovered from neurological complications (88 per cent). One patient with tuberculosis did not improve after prolonged treatment and 2 patients infected with S aureus died (8 per cent). CONCLUSIONS: Spondylodiscitis is associated to a diversity of microbial agents and in most cases has a favorable prognosis.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Discite/microbiologia , Vértebras Lombares/microbiologia , Discite/diagnóstico , Discite/terapia , Estudos Retrospectivos , Imageamento por Ressonância Magnética , Infecções Estafilocócicas/complicações , Sedimentação Sanguínea , Seguimentos , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/complicaçõesRESUMO
We report a case of Aspergillus terreus discitis which developed in a patient with acute lymphoblastic leukemia following induction chemotherapy. A. terreus was isolated from sputum, one month earlier, but the physician did not consider it significant at the time. Magnetic resonance imaging study showed the involvement of L3-4, L4-5 and L5-S1 intervertebral discs. Etiology was established by means of histology and culturing a surgical specimen of disc materials. Our patient survived after a surgical debridement and amphotericin B administration with a total dose of 2.0 g. Discitis caused by Aspergillus terreus is a very rare event. A. terreus is one of the invasive Aspergillus species. The pathogenetic mechanism is discussed and the literature is reviewed.
Assuntos
Humanos , Aspergilose/cirurgia , Aspergilose/patologia , Aspergilose/microbiologia , Aspergilose/tratamento farmacológico , Aspergilose/complicações , Aspergillus/isolamento & purificação , Aspergillus/classificação , Artigo de Revista , Discite/cirurgia , Discite/patologia , Discite/microbiologia , Discite/tratamento farmacológico , Disco Intervertebral/cirurgia , Disco Intervertebral/patologia , Disco Intervertebral/microbiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/microbiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Vértebras Lombares/cirurgia , Vértebras Lombares/patologia , Vértebras Lombares/microbiologiaRESUMO
Os autores apresentam 3 casos de discite lombar tratados em curto espaço de tempo, sem relaçäo com cirurgia prévia de hérnia de disco. Embora seja difícil determinar a causa exata, um deles teve a infecçäo provavelmente relacionada com infecçäo urinária e septicemia desenvolvida após cirurgia da próstata; o outro teve abscesso perianal várias semanas após o início dos sintomas e o último apresentou quadro típico de hérnia de disco traumática e provável infecçäo sobreposta ao disco herniado. Os 3 pacientes foram tratados cirurgicamente com ótimos resultados. É feita uma discussäo em torno desta patologia relativamente rara