Endocarditis de Libman-Sacks: una manifestación frecuentemente inadvertida / Libman-Sacks’ endocarditis: A frequently unnoticed complication

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Streptococcus bovis septic arthritis and osteomyelitis: A report of 21 cases and a literature review.

BACKGROUND: The Streptococcus bovis group (SBG) is a well-known cause of endocarditis, but its role in osteoarticular infections (OAIs) has not been well described. METHODS: We analyzed all patients with OAIs by SBG diagnosed in our hospital (1988-2014). We selected those cases with septic arthritis and osteomyelitis, as defined according to clinical, microbiological, and imaging studies. Identification of the strains was performed by using the API 20 Strep and the GP card of the Vitek 2 system, and confirmed the identification by molecular methods. In addition, we reviewed the literature to select all cases of OAI by SBG during the period 1980-2015. RESULTS: From the 83 cases of OAI included in the analysis (21 from our center and 62 from the literature review), 59 were osteomyelitis (57 of them spondylodiscitis) and 24 were arthritis (2 with associated spondylodiscitis). The mean age was 66.9 years, and 79.2% of the patients were men. Endocarditis (IE) was associated with 59% of the cases and this association was greater for osteomyelitis than for arthritis (78.9% vs. 13.6%; P = 0.001). OAI was a presenting symptom in 63% of the cases of IE. Colonoscopy was performed in 64 cases, which detected colorectal neoplasm (CRN) in 46 patients (71.8%), almost all asymptomatic. Some 69.5% of these neoplasm were carcinomas or advanced adenomas. The blood cultures were positive in 78.3% cases. In 45 cases, the S. bovis species was identified; in 82.2% of the cases the cause was Streptococcus gallolyticus subsp. gallolyticus. The mortality was 7.2%, which in no case was attributable to the OAI. CONCLUSIONS: OAIs are frequently the initial manifestation of IE caused by SBG. S. gallolyticus causes most of these infections. Echocardiogram and colonoscopy are therefore mandatory, given the species' close association with IE and CRN.

Persistent left superior vena cava draining into the coronary sinus: report of 10 cases and literature review.

BACKGROUND: Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. HYPOTHESIS: This study examines the epidemiologic, clinical, and morphologic characteristics of a cohort of patients with PLSVC draining into the coronary sinus. METHODS: We examined the clinical and morphologic characteristics of patients with PLSVC draining into the coronary sinus diagnosed at a single referral hospital for a defined population in northwestern Spain. We designed a prospective study of the case records of all patients diagnosed with PLSVC draining into the coronary sinus at the echocardiography laboratory of the Hospital Xeral-Calde from January 2001 through December 2002. Patients were included if they had a PLSVC diagnosed by transthoracic echocardiogram (TTE) using an echo-contrast enhancement and confirmed by a magnetic resonance (MR) imaging. Ten patients (6 women) fulfilled the inclusion criteria described above. All patients were adults and had associated heart disease, including a congenital heart disease in three cases. RESULTS: Magnetic resonance imaging examination confirmed the presence of PLSVC and the site of drainage into the coronary sinus. Absence of the right superior vena cava was observed only in three patients, in whom the main coronary sinus size was significantly increased. Absence of the left brachiocephalic vein was diagnosed in five patients. CONCLUSION: This study describes 10 new cases of PLSVC and supports the necessity of considering PLSVC draining into the coronary sinus in the diagnosis of patients presenting with dilated coronary sinus diagnosed by TTE. It also underlines the important role of MR imaging in the evaluation of these abnormalities. An associated heart disease must always be excluded in these patients.

Síndrome de Kallmann: hallazgos por resonancia magnética / Kallmann's syndrome: magnetic resonance findings

El síndrome de Kallmann es una entidad poco frecuente, que se caracteriza por hipogonadismo hipogonadotropo asociado a anosmia o hiposmia. Morfológicamente, se caracteriza por un desarrollo defectuoso del sistema olfatorio, con ausencia o extrema hipoplasia de los bulbos, cintillas y surcos olfatorios. Presentamos un caso de síndrome de Kallmann en el que la resonancia magnética aportó datos distintivos de la entidad (AU)

Fatigue fractures suggesting clinical monarthritis.

OBJECTIVE: To examine etiologic factors, clinical features, and outcome in a series of consecutive patients with fatigue fractures diagnosed at a rheumatology division for a defined population over a 14-month period. METHODS: A prospective study of the patients diagnosed with fatigue fracture at the rheumatology division of the Hospital Xeral-Calde (Lugo, Spain) between July 2000 and August 2001 was conducted. Hormonal status, body mass index, lifestyle, job, underlying diseases, and drug intake, which might be attributable risk factors for the stress fracture, were assessed. In all the patients a followup of at least 6 months was required. RESULTS: Six consecutive patients (4 women) fulfilled the inclusion criteria. All of them were younger than 65 years (median 45 years; range 36-64 years) and had a body mass index lower than 25. In this series no distinctive occupation was found. The delay to diagnosis since the onset of symptoms ranged from 0.5 to 6 months (median 1.5). All patients but 1 were sent to the rheumatology division because of a clinical diagnosis of monarthritis. Pain and swelling were the presenting symptoms. Conventional radiographs were normal and fine needle aspiration of the joints yielded negative results for microcrystals and organisms. Magnetic resonance imaging disclosed the presence and site of fracture in all the cases. Sequelae of mechanical pain and subsequent osteoarthritis were observed in the 3 cases with longer delay to diagnosis. CONCLUSION: Fatigue fractures are not exceptional in unselected adults. Rheumatologists should consider this diagnosis in patients presenting with monarthritis. Physician awareness is required to prevent the development of sequelae.

Fracturas por insuficiencia del sacro: a propósito de tres casos / Sacral insufficiency fractures: a report of three cases

Las fracturas por insuficiencia del sacro costituyen un problema diagnóstico ya que la clínica es inespecífica y no suelen presentar alteraciones en los estudios radiológicos convencionales.La causa fundamental es la osteoporosis, siendo las mujeres en edad posmenopáusica el grupo más frecuentemente afectado, y/o tratamiento radioterápico previo, lo que hace que en el diagnóstico diferencial se incluya la patología neoplásica.Resulta esencial conocer la localización característica en alas sacras, frecuentemente bilateral, con un trayecto vertical paralelo a las articulaciones sacroilíacas, pudiendo combinarse con un componente transverso sobre el cuerpo sacro (patrón en H). También es frecuente la afectación de la región medial de huesos ilíacos y la asociación con fracturas de la región supraacetabular y sínfisis púbica.La TC es el método diagnóstico de elección al revelar la línea de fractura y/o esclerosis, si bien su sensibilidad es menor que la RM o la gammagrafía en el período agudo.En la RM se visualizan como edema inespecífico en las localizaciones descritas, pudiendo demostrarse la línea de fractura en general con hiposeñal en T2, que contrasta con el edema. El empleo de gadolinio o supresión de la grasa aumenta la sensibilidad.La gammagrafía ósea tiene una alta sensibilidad diagnóstica aunque la presentación de un patrón específico 'en H' acontece en menos del 50 por ciento de los casos (AU)

Comparación entre colangiografía por resonancia magnética (CPRM) y colangiografía retrógrada endoscópica (cpre) / Comparison between magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP)

Objetivo: Valorar la correlacióm entre la colangiografía por resonancia magnética (CPRM) y la colangiografía retrógrada endoscópica (CPRE).Material y métodos: Estudio prospectivo de 71 pacientes con sospecha de patología biliar. Realización de CPRM y posteriormente de CPRE. La CPRM se realizó con un equipo de 1,5 T con hipergradientes, bobina 'phase array' abdominal y secuencias 'single-shot fast spin-echo' (SSFSE) con máxima potenciación en T2. Con esta secuencia sólo se ven los líquidos, consiguiéndose imágenes similares a las obtenidas por CPRE. Se tomó como patrón de referencia los resultados de la CPRE.Resultados: En 30 pacientes se demostró estenosis (19 malignas y 11 benignas), en 25 coledocolitiasis y en 16 no se encontraron alteraciones.La correlación fue total en los casos de estenosis. La CPRM detectó 23 coledocolitiasis (en las dos restantes la colangiografía por CPRE fue normal, pero salieron cálculos tras esfinterotomía). La CPRM confirmó la normalidad de la vía biliar en 12 de los 16 pacientes normales (dos pacientes con CPRE normal se diagnosticaron de dilatación biliar por coledocolitiasis 24 horas y 10 días antes respectivamente, y dos supuestas ectasias por fibrosis del Oddi mostraron un buen vaciado durante la CPRE).Conclusión: La CPRM con técnica SSFSE muestra una alta correlación con la CPRE, que se reservaría para casos dudosos o que precisen terapia endoscópica (AU)