ABSTRACT
BACKGROUND: Neuropathic arthropathy (NA) of the shoulder is a chronic progressive process characterized by joint destruction in the presence of a neurosensory deficit. Syringomyelia, a spinal cord disease, is the leading cause of NA in the upper extremity. OBJECTIVE: We present a systematic review of NA with syringomyelia cases alongside a case report of an adult with NA of the shoulder that occurs a few 4 years after a revelation and surgical management of a Chiari malformation with syringomyelia. METHODS: A systematic review was conducted following PRISMA guidelines. A PubMed, Scopus, Isiknowledge, and manual search through references of relevant publications were used to identify all published case reports of NA. Data were collected from each case report on patient characteristics. RESULTS: The systematic review identified 56 publications and 85 patients (including ours): nearly the same number of males (n = 41) and females (n = 44). The mean age was 50,69. Presentations included reduction of mobility (n = 66), swelling (n = 61) and sensory disorder (n = 63). The pain was absent in 41 cases. In the majority of reported cases 56 (65.1%), syringomyelia was revealed by neuropathic arthropathy, and eleven patients (12.9%) had a history of syringomyelia. Treatment was categorized into non-operative management (37[43.5%]), operative management (27[31.7%]). Following-up was non-reported in 31 (36%) cases. Improvement was reported more with patients who underwent a surgical approach than medical one 28.5% versus 8.1%. CONCLUSION: Physicians need to be more aware of this destructive joint disease, rare, and often misdiagnosed. Also, it is imperative to integrate clinical, pathological, and imaging findings for accurate diagnosis and for delivering appropriate therapy.
Subject(s)
Arnold-Chiari Malformation , Arthropathy, Neurogenic , Shoulder Joint , Syringomyelia , Adult , Arnold-Chiari Malformation/complications , Arnold-Chiari Malformation/diagnostic imaging , Arnold-Chiari Malformation/surgery , Arthropathy, Neurogenic/diagnostic imaging , Arthropathy, Neurogenic/etiology , Arthropathy, Neurogenic/surgery , Female , Humans , Magnetic Resonance Imaging/adverse effects , Male , Shoulder/pathology , Syringomyelia/complications , Syringomyelia/diagnostic imaging , Syringomyelia/surgery , Upper Extremity/pathologySubject(s)
Pemphigus/diagnosis , Administration, Oral , Adult , Age Factors , Aged , Aged, 80 and over , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Biopsy , Cyclophosphamide/administration & dosage , Cyclophosphamide/therapeutic use , Drug Therapy, Combination , Female , Fluorescent Antibody Technique , Follow-Up Studies , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Pemphigus/drug therapy , Pemphigus/epidemiology , Pemphigus/pathology , Prednisone/administration & dosage , Prednisone/therapeutic use , Sex Factors , Skin/pathology , Time FactorsABSTRACT
Actinomyces is an anaerobic, gram-positive bacteria saprophyte of the oral cavity, lungs, genital and gastro-intestinal tracts. Tubo-ovarian infection is rare. The authors report a case of tubo-ovarian abscess, due to actinomyces ruptured in the sigmoid and diagnosed in a 30-year-old woman using an intra-uterine device for more than 5 years. After salpingo-oophorectomy and partial sigmoid resection, pathology confirmed the diagnosis.
