Septic superficial thrombophlebitis in Klippel-Trenaunay syndrome.

This is a rare case of a young patient with Klippel-Trenaunay syndrome that presented with extensive septic superficial thrombophlebitis of the lower extremity. Treatment included intravenous antibiotics based on cultures, anticoagulant therapy as well as surgical removal of thrombi.

Endophthalmitis Due to Proteus vulgaris after Pars Plana Vitrectomy with Devastating Outcome.

Postoperative infectious endophthalmitis is rare, yet devastating loss of vision or loss of the eye can occur due to a highly purulent microorganism or uncontrolled endophthalmitis that may spread to all coats of the eye. We report, herewith, a case of rapidly progressive postoperative endophthalmitis after pars plana vitrectomy which ended up with enucleation. The isolated microorganism was Proteus vulgaris which has not been reported as causative bacteria of postoperative infections following pars plana vitrectomy.

Treatment of Atypical Compartment Syndrome Due to Proteus Infection.

Compartment syndrome is an orthopedic emergency with a multitude of etiologies. Although it is most commonly associated with trauma to the extremity, hematoma and infection are 2 rare etiologies of insidious compartment syndrome. Proteus mirabilis is an opportunistic gram-negative species that can infect the respiratory tract, urinary tract, and open wounds. The authors present the case of a 69-year-old woman who developed tissue necrosis and compartment syndrome secondary to an untreated hematoma infected by P mirabilis. This case involves an atypical presentation caused by an untreated infected hematoma, emphasizing the need for a high index of suspicion. Current literature supports immediate surgical intervention in the clinical scenario of fulminant compartment syndrome, regardless of compartment pressure findings. The probability of compartment syndrome in the patient presenting with pain, paresthesias, paresis, and pain with passive stretch, all of which were positive findings in this patient, has been reported to be 98%. Thus, Doppler evaluation and intercompartmental pressures were considered but forgone to expedite operative treatment. Emergent 4-compartment fasciotomies, with excision and debridement of nonviable tissue, are potentially limb-saving procedures, intended to limit loss of function and obviate the need for lower extremity amputation. The decision was made to perform a dual-incision fasciotomy to avoid contamination of the uninvolved compartments with a standard single-incision approach. To date, this represents the first report in the English literature of the insidious onset of tissue necrosis secondary to a Proteus-infected hematoma, highlighting a unique etiology of atypical compartment syndrome. [Orthopedics. 2017; 40(1):e176-e178.].

Proteus mirabilis abscess involving the entire neural axis.

Intramedullary spinal cord abscesses are rare and potentially devastating lesions usually associated with other infective processes such as bacterial endocarditis, or pulmonary or urogenital infection. We describe a 2-year-old girl who presented with an infected dermal sinus leading to an intraspinal abscess. This abscess eventually spread and involved the entire neural axis leaving her quadriparetic. Drainage of the abscess resulted in recovery and the child regained normal function of her limbs. To our knowledge this is the first documented case of an intramedullary abscess involving the entire neural axis.

[Infected subdural hematoma having a surgery of chronic subdural hematoma 1 year ago:a case report].

We report a case of an infected subdural hematoma that occurred 1 year after burr-hole irrigation for chronic subdural hematoma. A 78-year-old woman who had developed left hemiparesis was admitted to our hospital. A computed tomography(CT)scan revealed the presence of a chronic subdural hematoma in the right hemisphere. Her clinical symptoms improved immediately after emergency burr-hole irrigation, which allowed her discharge from the hospital. One year after the initial surgery, she developed an infection of the urinary tract infection, which led to severe pyelonephritis and septic shock. Treatment of the urological symptoms eliminated the systemic inflammation. One month after the urinary infection, the patient was readmitted to the hospital in a comatose state. A CT scan showed regrowth of a residual subdural hematoma surrounded by a thick capsule, causing a midline shift in the brain. An emergency operation for removal of the subdural hematoma by burr-hole irrigation was performed, and pus was drained from the subdural mass. Microbiological cultures of the abscess revealed the presence of Proteus mirabilis. After surgery, the patient was administered an antibiotic treatment for three weeks and she was discharged with no neurological deficits. Cultures of blood from the septic shock as well as from the abscess both revealed the presence of Proteus mirabilis. Therefore, a diagnosis of infected subdural hematoma, which was caused by hematogenous infection, was made. We conclude that attention should be paid to the risk of infection of the hematoma capsule in subdural hematomas.

Mucus accumulation and necrosis of the ventral air pouch in a marabou stork (Leptoptilos crumeniferus) with productive rhinitis.

A captive-born marabou stork (Leptoptilos crumeniferus) was presented for swelling of the ventral air pouch of 1 month's duration. The pouch appeared fluid filled, and its distal third wall was markedly inspissated. The thickened distal portion of the pouch wall was removed surgically. During anesthesia, mucous discharge from the nares was evident and the nasal mucosa was hyperemic. Aeromonas and Proteus species were isolated from a nasal culture. Postoperative therapy that consisted of nasal flushing, antimicrobial agents, and nonsteroidal anti-inflammatory drugs was effective in managing the disease. On histologic examination, diffuse hemorrhage, necrosis, and multifocal vasculitis with moderate-to-severe heterophilic inflammation were present within sections of the ventral pouch. To our knowledge this is the first report of a mucus-filled ventral air pouch with associated pathologic changes secondary to a productive infection of the upper respiratory tract in a marabou stork. The unique communication between nasal cavities and the ventral air pouch should be considered in future cases of respiratory infection in marabou storks.

[One-stage revision of knee endoprosthesis due to periprosthetic infection and Klippel-Trenaunay syndrome]. / Einzeitiger Knieendoprothesenwechsel bei periprothetischer Infektion und Klippel-Trenaunay-Syndrom.

We present the case of a patient with Klippel-Trenaunay syndrome (KTS) who underwent a one-stage revision of an infected total knee arthroplasty. A detailed orthopedic description of KT is presented as well as a discussion on the implementation of one-stage or multi-stage revision following infections of total knee arthroplasty. Due to vascular anomalies with severe coagulation problems, soft tissue swelling and increased risk of infection, surgical treatment of such patients presents a special challenge.

Management of chronic gangrenous mastitis in a 3-year-old cow using partial (quarter) mastectomy.

Bovine gangrenous mastitis is an acute or peracute condition involving one or more quarters of the cow's udder. It occurs infrequently, but when it occurs, mortality of the affected cows is high. A partial mastectomy of one quarter using a cranial epidural analgesia with 2% lignocaine is described to manage a gangrenous mastitis affecting only one quarter caused by Proteus mirabilis (a gram-negative bacteria) which was not amenable to medical treatment. Partial mastectomy can be a safe and effective procedure for ruminants with udder disease in genetically or otherwise valuable cattle.

Bilateral atticoantral chronic suppurative otitis media presenting as bilateral cutaneous mastoid fistulas.

Postauricular cutaneous mastoid fistula secondary to chronic suppurative otitis media (CSOM) is an unusual complication. Bilateral manifestation along with primary acquired cholesteatoma and atelectasis of the pars tensa as an end-stage complication in the natural course of atticoantral CSOM is rare. This kind of complication has a very morbid effect on the ear, and it poses a therapeutic challenge in terms of eradicating disease and restoring function. In this article, we describe the unusual course of an atticoantral CSOM that (1) began as a primary acquired cholesteatoma simultaneously in both ears, (2) proceeded to automastoidectomy and a severe mixed hearing loss bilaterally, and (3) ended with the development of bilateral cutaneous mastoid fistulas that served to arrest the further progression of the disease process on its own. This case serves as a good demonstration of how a ventilating mastoid fistula can change the natural course of atticoantral CSOM and abort the occurrence of deadly complications.

[A very extensive necrotizing fasciitis]. / Une fasciite nécrosante très extensive.

Necrotizing fasciitis is a severe skin infection. Fluidized bed may be indicated to improve healing. We report a 36-year-old woman case, who developed an important skin emphysema on a fluidized bed that may have worsen the situation.

Presentation, treatment, and clinical course of otogenic lateral sinus thrombosis.

CONCLUSIONS: Otogenic lateral sinus thrombosis (OLST) is almost always associated with other complications of chronic otitis media (COM) and did not present a distinct clinical expression. In our experience, OLST exhibits a benign course if the underlying disease is controlled. Mastoidectomy in combination with broad-spectrum antibiotics provided effective treatment. Anticoagulation therapy is no longer used routinely. Recanalization is rare and is independent of the use of anticoagulants. OBJECTIVES: This study aimed to contribute to the understanding of the clinical aspects and evolution of OLST. PATIENTS AND METHODS: The study investigated a retrospective case series in a tertiary teaching hospital. From 1993 to 2007, eight cases of OLST were treated. The clinical and imaging data, treatments, and outcomes were analyzed. The follow-up period ranged from a minimum of 6 months to 5 years. RESULTS: In all eight patients, the lateral sinus thrombosis was detected by imaging studies performed to evaluate complications and symptoms related to COM. Fever, headache, and cranial nerve paralysis were the main clinical manifestations associated with coexisting mastoiditis, meningitis, and cerebellar and epidural abscess. We could not identify features specific to lateral sinus thrombosis in any case. All patients underwent mastoidectomy and were given broad-spectrum antibiotics for 2 months. Four cases were anticoagulated and all eight cases experienced complete clinical recovery without sequelae.

[Septic arthritis of the wrist]. / Die septische Arthritis des Handgelenks.

BACKGROUND: Septic arthritis of the wrist is correlated with a high morbidity. To show diagnostic and therapeutic options we reviewed the patients treated with wrist infections at our institution for one year. METHODS: The data of ten patients who were treated for septic arthritis of the wrist in 2003 and 2004 were collected in a retrospective survey. Etiology, risk factors, microorganism and resistance data were recorded. RESULTS: Six infections were of an iatrogenic nature (four following surgery, one joint puncture and one joint injection). In nine cases there was a single arthritis of the wrist. One patient had oligoarthritis. In four cases Staphylococcus aureus, in one Proteus mirabilis and in one Pseudomonas aeroginosa were identified. In four cases, no microorganism could be identified. Two of the patients suffered from diabetes mellitus, one had rheumatoid arthritis. There was no significant elevation in the white blood cell count with 9.2 (4.5 - 12.5) x 10 (9)/L. Arthroscopic debridement and synovialectomy could be performed in one case. In the other cases open surgery was necessary. In four cases partial bone resection was required. Local antibiotics were installed in eight cases. All infections healed. In nine patients the joint was immobilized with an external fixation device. All patients received systemic antibiotics. Four wrists ended in an arthrodesis, one in a four-corner fusion. On average, two (1 - 6) surgical interventions were necessary per patient. The six patients without an arthrodesis had a range of motion in extension/flexion of 30-0-24 degrees. CONCLUSION: Surgical treatment is sufficient in septic arthritis of the wrist. However, an early diagnosis and therapeutic intervention are essential to avoid a permanent disability.

Multifocal Proteus mirabilis osteomyelitis requiring bilateral amputation in an HIV-positive patient.

We present a rare case of multifocal Proteus mirabilis osteomyelitis in an HIV-positive patient. Despite the patient's good immune status as assessed by her CD4 cell count and the aggressive treatment, she eventually underwent bilateral above-knee amputations to eradicate the infection. Multifocal Proteus mirabilis osteomyelitis can have an unpredictable clinical course with a severe outcome in HIV-positive patients.

[Xanthogranulomatous pyelonephritis: presentation of an unusual case]. / Xanthogranulomatöse Pyelonephritis: Präsentation eines ungewöhnlichen Falles.

INTRODUCTION: Xanthogranulomatous pyelonephritis is a morphologically and clinically unique manifestation of chronic pyelonephritis with the formation of pus or granulomas. The most frequent predisposing factors for the development of xanthogranulomatous pyelonephritis are urinary obstruction (e. g., stones, tumors, congenital anomalies and functional impairment) and infection of the collecting system. CASE REPORT: We describe a 2-year-old female patient with unclear abdominal complaints, diarrhea, malaise, loss of appetite, weight loss, pale skin color, and recurrent and undulating fever in the presence of known left nephrolithiasis. Based on the clinical examination and imaging, above all, CT, the presumptive diagnosis of xanthogranulomatous pyelonephritis of the left kidney was made. A left lumbar nephrectomy was performed and histology confirmed the diagnosis. CONCLUSION: Xanthogranulomatous pyelonephritis is a relatively rare entity that is associated with obstruction (e. g., stones) and infection of the urinary tract. Its rarity and resultant unfamiliarity often delay diagnosis and therapy, which in turn affect the prognosis. Furthermore, this entity can be mistaken for renal tumors (renal cell carcinoma and Wilms tumor), but nowadays this should be mostly eliminated with the advances in the imaging methods.

Successfully treated mitral valve Proteus mirabilis endocarditis.

Infective endocarditis caused by Proteus mirabilis is rare and is fatal in most cases. A case of a 64-year-old man presenting with fever, dysuria, and murmur is reported. P mirabilis endocarditis was diagnosed based on clinical presentation, blood culture findings, and the presence of a large mitral valve vegetation seen on echocardiogram. The patient survived after long-term antibiotics and surgical replacement of the mitral valve. The clinical characteristics and complications from reported cases of P mirabilis endocarditis are reviewed.

[Bladder rupture caused by spontaneous perforation of an infected urachal cyst]. / Blasenruptur durch spontane Perforation einer infizierten Urachuszyste.

Anomalies of the fetal urachus are rare. Normally, the postnatal urachus presents as a fibrous band extending from the bladder to the umbilicus. Urachal cysts may occur in postnatal life. Spontaneous perforation of urachal cysts is a very rare condition, which clinically may not be distinguishable from other acute abdominal conditions. We report a case of a 63-year-old male with a history of recurrent urinary tract infections and a bladder rupture caused by a spontaneous perforation of an infected urachal cyst. The symptomatology showed abdominal rigidity and pain, a palpable mass in the lower abdomen, and hematuria. Laboratory findings showed leukocytosis and an increased CRP level. The bladder rupture was confirmed by cystography. Bacteriologic examination identified Proteus vulgaris, Corynebacterium species, and Klebsiella pneumoniae. Most of the published cases in the literature report about intraperitoneal perforation of infected urachal cysts. In the present case, we found a spontaneous perforation of an infected urachal cyst leading to an extraperitoneal bladder rupture with an extraperitoneal limitation of the infection. The definitive therapy was complete surgical excision including a cuff of the bladder, drainage, and systemic broad-spectrum and local application of antibiotics. The further course was uneventful.