ABSTRACT
Cryptococcosis is an opportunistic infection caused by the Basidiomycota Cryptococcus neoformans (Cryptococcus gattii), which affects immunosuppressed patients and less frequently immunocompetent patients. Solid-organ transplant recipients are a particularly high-risk group, depending on the net state of immunosuppression. In these patients, the infection usually appears after the first year after transplant, although it may occur earlier in liver transplant recipients. In most cases, the infection is secondary to the reactivation of a latent infection, although it may be due to an unidentified pretransplant infection by primary infection. Less frequently, it may be transmitted by the graft. The lung and central nervous system are most frequently involved. Extrapulmonary involvement is seen in 75% of the cases, and disseminated disease occurs in 61%, with mortality ranging from 17% to 50% when the central nervous system is involved. Here, we report a case of disseminated cryptococcosis (lymphadenitis, meningitis, pulmonary nodules, and possibly sacroiliitis) in a patient after liver transplant, with good clinical and microbiological outcomes and without relapse.
Subject(s)
Cryptococcosis/microbiology , Liver Transplantation/adverse effects , Lung Diseases, Fungal/microbiology , Lymphadenitis/microbiology , Opportunistic Infections/microbiology , Sacroiliitis/microbiology , Adult , Antifungal Agents/therapeutic use , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Cryptococcosis/immunology , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/immunology , Lymphadenitis/diagnosis , Lymphadenitis/drug therapy , Lymphadenitis/immunology , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/immunology , Meningitis, Cryptococcal/microbiology , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Sacroiliitis/diagnosis , Sacroiliitis/drug therapy , Sacroiliitis/immunology , Treatment OutcomeABSTRACT
Sacroiliitis, a condition commonly seen in ankylosing spondylitis, is well known to be one of the main pain generators of low back pain, which may result in difficulty with walking. A 20-year old male with history of ankylosing spondylitis presented to the University Hospital of the West Indies, Physical Medicine and Rehabilitation Clinic, with a two-year history of right buttock, low back and groin pain. Radiographic evaluation revealed increased sclerosis and erosive changes in bilateral sacroiliac joints, right greater than left. Right intra-articular sacroiliac joint steroid injection was administered under fluoroscopy guidance. Post-injection visual analogue pain scale (VAS) score with activity improved from 8 to 1 and Oswestry Disability Index improved from 40% moderate disability to 16% minimal disability. The patient's overall assessment was 95% perceived improvement in pain. This case report illustrates the effectiveness of intra-articular sacroiliac joint steroid injection in treating sacroiliitis in ankylosing spondylitis.
La sacroilitis, una condición comúnmente vista en la espondilitis anquilosante, es bien conocida por ser uno de los principales generadores de dolor lumbar, que puede ocasionar dificultad para caminar. Un paciente de 20 años de edad con una historia de espondilitis anquilosante, acompañada de dos años de dolor en la nalga derecha, la región lumbar, y en la ingle, acudió a la Clínica de Rehabilitación y Medicina Física del Hospital Universitario de West Indies. La evaluación radiográfica reveló esclerosis aumentada y cambios erosivos en la articulación sacroilíaca bilateral, mayor en el lado derecho que en el izquierdo. Con la ayuda de la fluoroscopia para guiar el procedimiento, se le administró al paciente una inyección intraarticular de esteroide en la articulación sacro-ilíaca, al lado derecho. La puntuación de la escala analógica visual del dolor (VAS) tras la inyección mejoró de 8 a 1, y el Índice de Discapacidad de Oswestry mejoró de una discapacidad moderada del 40% a una mínima discapacidad del 16%. La evaluación general del paciente fue de un 95% en cuanto a la percepción de la mejoría del dolor. Este reporte de caso ilustra la eficacia de la inyección intraarticular de esteroides de la articulación sacroilíaca para el tratamiento de la sacroiliitis en la espondilitis anquilosante.
Subject(s)
Humans , Male , Young Adult , Spondylitis, Ankylosing/drug therapy , Fluoroscopy/methods , Sacroiliitis/drug therapy , Spondylitis, Ankylosing/complications , Steroids/administration & dosage , Treatment Outcome , Sacroiliitis/etiology , Injections, Intra-Articular/methodsSubject(s)
Behcet Syndrome/diagnosis , Behcet Syndrome/epidemiology , Magnetic Resonance Imaging , Sacroiliitis/diagnosis , Sacroiliitis/epidemiology , Adrenal Cortex Hormones/therapeutic use , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Behcet Syndrome/drug therapy , Colchicine/therapeutic use , Drug Therapy, Combination , Female , Humans , Methotrexate/therapeutic use , Sacroiliac Joint/pathology , Sacroiliitis/drug therapy , Treatment OutcomeSubject(s)
Abscess/diagnostic imaging , Community-Acquired Infections/diagnostic imaging , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Myositis/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Tomography, X-Ray Computed , Abscess/drug therapy , Abscess/microbiology , Abscess/surgery , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Community-Acquired Infections/surgery , Debridement , Drainage , Drug Therapy, Combination , Female , Humans , Immunocompetence , Middle Aged , Myositis/drug therapy , Myositis/microbiology , Myositis/surgery , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Osteomyelitis/surgery , Periosteum/microbiology , Periosteum/surgery , Psoas Abscess/diagnostic imaging , Psoas Abscess/drug therapy , Psoas Abscess/microbiology , Psoas Abscess/surgery , Recurrence , Sacroiliitis/drug therapy , Sacroiliitis/microbiology , Sacroiliitis/surgery , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcal Infections/surgery , ThighSubject(s)
Abscess/diagnostic imaging , Community-Acquired Infections/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Myositis/diagnostic imaging , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Tomography, X-Ray Computed , Psoas Abscess/surgery , Psoas Abscess/diagnostic imaging , Psoas Abscess/microbiology , Psoas Abscess/drug therapy , Abscess/surgery , Abscess/microbiology , Abscess/drug therapy , Anti-Bacterial Agents/therapeutic use , Thigh , Debridement , Drainage , Female , Humans , Immunocompetence , Community-Acquired Infections/surgery , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Staphylococcal Infections/surgery , Staphylococcal Infections/microbiology , Staphylococcal Infections/drug therapy , Myositis/surgery , Myositis/microbiology , Myositis/drug therapy , Osteomyelitis/surgery , Osteomyelitis/microbiology , Osteomyelitis/drug therapy , Periosteum/surgery , Periosteum/microbiology , Middle Aged , Drug Therapy, Combination , Recurrence , Sacroiliitis/surgery , Sacroiliitis/microbiology , Sacroiliitis/drug therapy , Combined Modality TherapyABSTRACT
BACKGROUND: Antitumor necrosis factor (anti-TNF) agents are a well-established treatment for various medical conditions, including psoriasis and psoriatic arthritis. However, anti-TNF agents may themselves induce psoriasis in some patients. METHODS: The authors report two cases of patients with severe and refractory infliximab-induced psoriasis. RESULTS: The patients had good clinical responses after switching to another TNF blocker. CONCLUSION: For severe cases, infliximab withdrawal combined with conventional immunosuppressive psoriasis drugs or with adalimumab may be a therapeutic option.