Neuropathic arthropathy of the shoulder as a presenting feature of Chiari malformation with syringomyelia: a case report with a systematic literature review.

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.

[Clinical Features and Prognosis Factors of Spinal Tuberculosis in Northern Tunisia: A Case Series of 60 Patients]. / Profil clinique et facteurs pronostiques du mal de Pott au nord de la Tunisie : à propos de 60 cas.

Spondylodiscitis is a common but potentially serious form of extra-pulmonary tuberculosis. Very few descriptions are known from Tunisia. We have conducted a retrospective study including 60 cases of spinal tuberculosis, performed over a period of 20 years (1996-2016). The diagnosis was retained on bacteriological, radiological and anatomopathologic evidence. Sixty cases including 31 women and 29 men of spinal tuberculosis were involved. The mean age was 54.4 ±â€…21.3 years. The delay from onset to diagnosis was 6 months (1-14). Lumbar region was the most common infection site (68%). The magnetic resonance imaging has confirmed spinal infection in all cases. The percutaneous image guided spinal biopsy was conclusive in 24/42 cases (57.1%). All patients were put under anti-tuberculosis treatment with total treatment duration of 14 months. Fourteen patients underwent surgical act. The outcome was favorable in 42 cases (7%). Advanced age ≥ 65 years (P = 0.026), radiological evidence of spinal cord compression (P = 0.033) or abscess (P = 0.024), hyperleucocytosis higher than 11,500 elements/mm3 (0.031), or fractures on bone imaging (P = 0.018) and vertebral deformity (P < 0.001) were strongly linked to a bad outcome. Early diagnosis and treatment onset may ensure better outcomes and reduce neurological complications and vertebral deformity.

La spondylodiscite est une forme fréquente et potentiellement grave de tuberculose extrapulmonaire. Elle n'a été que peu décrite en Tunisie. Nous avons mené une étude rétrospective portant sur 60 cas de spondylodiscite tuberculeuse (SPDT) colligés sur une période de 20 ans (1996­2016) dans un centre hospitalier universitaire au nord de la Tunisie. Le diagnostic a été retenu sur des preuves bactériologiques, anatomopathologiques et radiologiques. Il s'agit de 31 femmes et de 29 hommes âgés en moyenne de 54,4 ±â€…21,3 ans. Le délai moyen de diagnostic était de six mois (1­14 mois). L'étage lombaire était le plus touché (68 %). L'imagerie par résonance magnétique était évocatrice du diagnostic dans tous les cas. La ponction-biopsie discovertébrale a permis de porter le diagnostic dans 24/42 cas (57,1 %), fondé sur des preuves histologiques. Tous les patients ont reçu un traitement antituberculeux d'une durée moyenne de 14 mois, associé à un geste interventionnel dans 14 cas. L'évolution était favorable dans 42 cas (70 %). Les facteurs de mauvais pronostic étaient l'âge avancé de plus de 65 ans (p = 0,026), la présence de signes radiologiques de compression médullaire (p = 0,033) ou d'abcès paravertébral (p = 0,024), l'hyperleucocytose initiale supérieure ou égale à 11 500 éléments/mm3 (p = 0,031), la présence de fracture vertébrale (p = 0,018) et d'une déformation vertébrale (p < 0,001). La SPDT est une maladie insidieuse dont le diagnostic et le traitement précoces sont la clé pour éviter les complications neurologiques et ostéoarticulaires.

Clinical and diagnostic features of trochanteric tuberculosis.

Trochanteric tuberculosis is a very rare localization of musculo-skeletal tuberculosis. The diagnosis is difficult and is often made in a late stage. The authors describe five cases of trochanteric tuberculosis. The mean age of patients was 46.6 years. Time to diagnosis was long (7.6 months on average). The tuberculosis was plurifocal in all cases. Diagnosis was based on positive Lowenstein culture in one case, on the presence of caseum granuloma in one case and through a pathognommonic manifestation in one case. For the remaining two cases, diagnosis was established on clinical and paraclinical arguments. The patients recovered after medical treatment alone.

[Brown tumor as an exceptional origin of lumbocruralgia with favourable outcome]. / La tumeur brune : cause exceptionnelle de lombo-cruralgie à évolution favorable.

INTRODUCTION: We report a case of a particular lumbar and radicular pain revealing primary hyperparathyroidism and discuss its characteristics through a literature review. CASE REPORT: A 55-year-old woman was hospitalized for a nerve root pain associated with recent weight loss with normal physical examination. Biology showed no evidence for acute phase response and normal kidney and liver functions. However, hypercalcemia and hypophosphatemia were evidenced. Radiographs of the lumbar spine showed a lytic lesion occupying the body of L4. A lumbar spine CT scan confirmed the presence of a compressive nerve root brown tumor. High level of PTH and parathyroid mass raised the possibility of the diagnosis of primary hyperparathyroidism. After parathyroidectomy all signs of hyperparathyroidism resolved with complete disappearance of spinal brown tumors in a two year follow-up CT scan. CONCLUSION: Although uncommon, brown tumor should be a diagnosis to consider in their presence of a spinal tumor. The improvement after conservative treatment could be dramatic.

Hepatocellular carcinoma with polymyositis as an initial symptom: a case report.

Patients with hepatocellular carcinoma may manifest paraneoplastic syndromes such as hypercholesterolaemia, hypoglycaemia, hypercalcaemia and erythrocytosis. An exceptional case of hepatocellular carcinoma associated with polymyositis, a rheumatic paraneoplastic syndrome, is reported. A 72-year-old male complained for a recent muscular weakness mainly in the proximal limb muscles. The clinical course, a raised level of serum creatine kinase and electromyographic findings suggested polymyositis, and the pathological findings on muscle biopsy were compatible with this diagnosis. Computed tomography of the upper abdomen revealed a mass lesion in segment IV, V and VII of the liver, and alpha foetoprotein level was high, resulting in the diagnosis of hepatocellular carcinoma.

[Infection of a tophaceous nodule of the middle finger]. / Infection d'un tophus goutteux de la main.

Gouty involvement of the hand is uncommon and the complications the most described are bony destruction, digital joint instability, tenosynovitis and double ipsilateral tunnel syndrome of the median and ulnar nerves at the wrist. Septic complications, such as infection of a tophaceous nodule, are a rare entity. The authors report a case of an infection of a tophaceous nodule of the middle finger in a 67-year-old man. The diagnosis was suspected on physical examination and radiological findings but final diagnosis is provided by bacteriological examination. This case is presented to heighten awareness of this rare entity and to provide a setting for a discussion of management.

[Cervicobrachial neuralgia revealing neurosarcoma]. / Névralgie cervicobrachiale révélatrice d'un neurofibrosarcome (MPNST) cervical.

Malignant peripheral nerve sheath tumor (MPNST) or neurofibrosarcoma, previously described as malignant Schwannoma or neurosarcoma, is an extremely rare cause of malignancy localized in the neck. Half of reported cases occurred in patients with neurofibromatosis in Von Recklinghausen disease type I. Typical features include high grade malignancy and a tendency to recurrence and distant metastases. We report the case of a 56-year-old woman with neurosarcoma of the neck, which was revealed by a cervicobrachial neuralgia. The physical examination found a mass on the left side of the neck. Plain radiographs showed osteoarthritis. MRI showed a well-defined paravertebral mass. Pathologic diagnosis was neurosarcoma. Radiotherapy was delivered.