RESUMEN
Calcium pyrophosphate dihydrate deposition disease is a common and potentially severe metabolic arthropathy. Early disease (in patients = 60 years old) requires a search for one of the associated metabolic conditions, particularly hemochromatosis. Treatment is primarily symptomatic (no drug is known to prevent the progression of articular destruction). Nonsteroidal anti-inflammatory drugs and intra-articular or systemic glucocorticoids (in small amounts if use is prolonged) are the most useful treatments. Colchicine can be effective to treat recurring pseudogout, and magnesium can be effective on a preventive basis. Methotrexate showed interesting effectiveness in a small, uncontrolled series, and it can be used in the event of failure of the other treatments.
Asunto(s)
Pirofosfato de Calcio/metabolismo , Condrocalcinosis/tratamiento farmacológico , Condrocalcinosis/metabolismo , Compuestos de Magnesio/uso terapéutico , Antiinflamatorios/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Condrocalcinosis/etiología , Colchicina/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Metotrexato/uso terapéutico , Probenecid/uso terapéutico , Uricosúricos/uso terapéuticoRESUMEN
UNLABELLED: Calcaneal osteomyelitis is uncommon and difficult to treat. Cases due to fistulization of an infected rheumatoid nodule are exceedingly rare. PATIENT: A 65-year-old patient with nodular rheumatoid arthritis (RA) experienced osteomyelitis of the left calcaneus due to inoculation from a fistula draining an ulcerated rheumatoid nodule. Pseudomonas aeruginosa and Enterobacter cloacae were recovered. The conventional treatment of calcaneal osteomyelitis relies on antibiotics and calcanectomy or foot amputation. We used two appropriate antibiotics and monthly intravenous injections of 90 mg of pamidronate. RESULT: One year into treatment, the patient was free of pain and the skin wound was fully healed. On a follow-up computed tomography (CT) scan, the fistulous tract was seen to be closed and the large calcaneal defect almost completely filled with new bone. CONCLUSION: Combining two antibiotics and pamidronate may be a viable alternative to excision surgery or amputation in some patients with bone infection carrying a risk of fracture.
Asunto(s)
Calcáneo , Fístula Cutánea/complicaciones , Osteomielitis/etiología , Nódulo Reumático/complicaciones , Úlcera/complicaciones , Anciano , Antibacterianos/uso terapéutico , Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/uso terapéutico , Quimioterapia Combinada , Estudios de Seguimiento , Humanos , Masculino , Osteomielitis/diagnóstico por imagen , Osteomielitis/tratamiento farmacológico , Pamidronato , Nódulo Reumático/diagnóstico por imagen , Nódulo Reumático/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
Staphylococcus warneri is a coagulase-negative staphylococcus that is a normal inhabitant of the skin but occasionally causes septicemia and endocarditis. We report a case of multifocal discitis caused by S. warneri in an immunocompetent patient. Only three cases of spinal S. warneri infections have been reported in the literature. They illustrate the atypical clinical presentation, with chronic pain of increasing severity in the thoracic or lumbar spine instead of the abrupt onset that characterizes S. aureus discitis. In our patient, despite the multifocal distribution of the lesions, heretofore unreported, clinical presentation suggested common low back pain. This presentation may be ascribable to the unique bacteriological characteristics of S. warneri. The case reported here illustrates the diagnostic challenges sometime raised by discitis due to coagulase-negative staphylococci.
Asunto(s)
Discitis/microbiología , Vértebras Lumbares , Anciano , Enfermedad Crónica , Coagulasa , Humanos , Dolor de la Región Lumbar/microbiología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/microbiología , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Masculino , Radiografía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Infecciones EstafilocócicasRESUMEN
We describe the case of a 71-year-old man with recurrent pseudogout attacks affecting multiple joints. He had end-stage renal failure that contra-indicated the use of non-steroidal anti-inflammatory drugs and was resistant to therapy with glucocorticoids. Based on the recent findings that interleukin (IL)-1beta is involved in crystal-induced inflammation, the patient received anakinra, a specific IL-1 inhibitor, in order to treat an acute attack of pseudogout. In addition, anakinra was administered as preventive therapy 3days per week after each hemodialysis session. Under this treatment, he did not present any severe episode of arthritis after a follow-up of 8 months. This observation suggests that anakinra is efficacious and safe for the prevention of crystal-induced arthritis in patients with severe renal failure.