[Coxsackie virus infection associated with myositis and polyarthritis]. / Miositis y poliartritis asociada a infección por virus Coxsackie B.

A wide spectrum of muscle disorders caused by Coxsackie B virus, ranging from acute nonspecific myalgia to rhabdomyolisis have been described. Arthritis in not widely recognised as an either manifestation of Coxsackie virus infection, and only ten patients has been reported previously. A case of polymyositis and polyarthritis associated with primary Coxsackie B infection in a 6-year-old girl is reported. Seroconversion of IgM and IgG antibodies for Coxsackie virus B was observed coinciding with the clinical features: fever, herpangine, polyarthritis, erythematous macular rash, myalgia and muscle weakness with high levels of aldolase and creatine kinase. Electromyographic changes of myositis were found. However, histopathologically biopsied muscle demonstrated a slight inflammatory mononuclear cell infiltrate without necrosis or regeneration of muscle fibres. Polyarthritis and full muscle strength was recovered 8 and 32 weeks after the onset, respectively.

Miositis y poliartritis asociada a infección por virus Coxsackie B / Coxsackie virus infection. Associated with myositis and polyarthritis

El espectro de la afectación muscular en las infecciones por virus Coxsackie B va desde mialgias inespecíficas hasta la rabdomiolisis. Por el contrario, las artritis han sido descritas en sólo diez pacientes hasta la fecha. Presentamos el caso de una niña de seis años con poliartritis y polimiositis asociadas a una infección por virus Coxsackie B. Se observó seroconversión para anticuerpos IgM e IgG coincidiendo con las manifestaciones clínicas, que incluyeron fiebre, herpangina, poliartritis, exantema macular, mialgias, debilidad muscular y elevaciones de la creatin-cinasa y aldolasa, así como patrón miopático en el estudio electromiográfico. La biopsia muscular sólo demostró un infiltrado inflamatorio linfocitario, sin necrosis ni regeneración de las fibras musculares. La poliartritis y la polimiositis se resolvieron totalmente a las 8 y 32 semanas de iniciado el cuadro clínico, respectivamente

A wide spectrum of muscle disorders caused by Coxsackie B virus, ranging from acute non specific myalgia to rhabdomyolisis have been described. Arthritis in not widely recognised as an either manifestation of Coxsackie virus infection, and only ten patients has been reported previously. A case of polymyositis and polyarthritis associated with primary Coxsackie B infection in a 6-year-old girl is reported. Seroconversion of IgM and IgG antibodies for Coxsackie virus B was observed coinciding with the clinical features: fever, herpangine, polyarthritis, erythematous macular rash, myalgia and muscle weakness with high levels of aldolase and creatine kinase. Electromyographic changes of myositis were found. However, histopathologically biopsied muscle demostrated a sligth inflammatory mononuclear cell infiltrate without necrosis or regeneration of muscle fibres. Polyarthritis and full muscle strength was recovered 8 and 32 weeks after the onset, respectively

[Pneumococcal spondylodiscitis and pleural effusion. Report of a case and literature review]. / Espondilodiscitis dorsal neumocócica y derrame pleural. Aportación de un caso y revisión de la literatura.

Streptococcus pneumoniae osteomyelitis in adults appears to be a rare event and, apart from isolated case reports, vertebral osteomyelitis due to this pathogen has rarely been reported. We described a immunocompetent 73-year-old woman who was admitted for fever, abdominal and inflammatory back pain. She was diagnosed of T10-T11 spondylodiscitis and right pleural effusion based on computed tomography and magnetic resonance imaging. Streptococcus pneumoniae was isolated from an aspirate of the vertebral foccus. The medical literature for other cases of pneumococcal spondylodiscitis was conducted from 1970 to 2005.

Espondilodiscitis dorsal neumocócica y derrame pleural. Aportación de un caso y revisión de la literatura / Pneumococcal spondylodiscitis and pleural effusion. Report of a case and literature review

En los adultos, las osteomielitis producidas por Streptococcus pneumoniae son muy infrecuentes y, excepto casos aislados, apenas hay referencias de osteomielitis vertebrales por este patógeno. Describimos una paciente de 73 años sin compromiso inmune, que fue ingresada por fiebre, dolor abdominal y dolor dorsal inflamatorio cuyo estudio llevó al diagnóstico de derrame pleural derecho y espondilodiscitis dorsal (D10- D11) en la que se aisló por punción aspirativa Streptococcus pneumoniae. Se revisa la literatura médica sobre espondilodiscitis neumocócicas entre 1970 y 2005

Streptococcus pneumoniae osteomyelitis in adults appears to be a rare event and, apart from isolated case reports, vertebral osteomyelitis due to this pathogen has rarely been reported. We described a immunocompetent 73-year-old woman who was admitted for fever, abdominal and inflammatory back pain. She was diagnosed of T10-T11 spondylodiscitis and right pleural effusion based on computed tomography and magnetic resonance imaging. Streptococcus pneumoniae was isolated from an aspirate of the vertebral foccus. The medical literature for other cases of pneumococcal spondylodiscitis was conducted from 1970 to 2005

Piomiositis, sacroiliitis y espondilodiscitis por Staphylococcus hominis en una mujer sin compromiso inmune / Pyomiositis, Sacroilitis and spondylodiscitis caused by staphilococcus hominis in a immunocompetent woman

Las infecciones osteoarticulares por estafilococos coagulasa negativos son raras en ausencia de factores de riesgo. Presentamos una paciente de 73 años, sin evidencia de compromiso inmune, que desarrolló piomiositis, sacroiliitis izquierda y espondilodiscitis involucrando las dos primeras vértebras dorsales por Staphylococcus hominis. El cuadro clínico infeccioso se desarrolló durante las cinco semanas que siguieron la administración de antiinflamatorios no esteroideos por vía intramuscular a causa de dolor lumbosacro asociado a una hernia discal L4-L5. Esta es la primera descripción conocida de una infección musculoesquelética multifocal por Staphylococcus hominis en una paciente no inmunocomprometida

In abscense of risk factors, osteoarticular infections by coagulase-negative staphylococci are very infrequent. We described the case of a immunocompetent 73-year-old-woman that suffered pyomyositis, left sacroiliitis and spondylodiscitis involving the first and second thoracic vertebrae by Staphylococcus hominis. This multifocal infection occurred five-weeks after intramuscular administration of NSAI for treatment of low back pain associated with a herniated disc L4-L5. This is the first know case of a multifocal muscleskeletal infection by Staphylococcus hominis in a patient immunocompetent

[Prosthetic knee infection caused by Listeria monocytogenes in a woman with rheumatoid arthritis and Waldenström s macroglobulinemia]. / Artritis séptica por Listeria monocytogenes sobre rodilla protésica en una paciente con artritis reumatoide y macroglobulinemia de Waldenström.

Listeria are gram-positive bacilli that can be isolated from soil and in the normal fecal flora of many mammals. It is a uncommon pathogen in the general population, but immunocompromised individuals can develop several focal infections, most notably meningoencephalitis and sepsis. Nevertheless, infectious arthritis caused by Listeria monocytogenes is a exceptional event. We report a new case of prosthetic knee arthritis due to Listeria in a woman with seropositive rheumatoid arthritis and Waldenström s macroglobulinemia receiving prednisone and methotrexate. In addition, we review the literature on listeria joint infections.

Artritis por Listeria monocytogenes sobre rodilla protésica en una paciente con artritis reumatoide y macroglobulinemia de Waldenström / Prosthetic knee infection caused by Listeria monocytogenes in a woman with rheumatoid arthritis and Waldenström´s macroglobulinemia

Listeria es un bacilo grampositivo que puede aislarse del suelo y de las heces de la mayoría de los mamíferos. Rara vez es patógena en la población sana, pero, en pacientes inmunocomprometidos, puede provocar diversas infecciones focales y, sobre todo, meningoencefalitis y sepsis. No obstante, las artritis sépticas son complicaciones excepcionales. Aportamos un nuevo caso de artritis séptica por L. monocytogenes sobre una prótesis de rodilla en una paciente con artritis reumatoide seropositiva y macroglobulinemia de Waldenström. Adicionalmente se revisa la literatura acerca de las infecciones articulares por Listeria

Listeria are gram-positive bacilli that can be isolated from soil and in the normal fecal flora of many mammals. It is a uncommon pathogen in the general population, but immunocompromised individuals can develop several focal infections, most notably meningoencephalitis and sepsis. Nevertheless, infectious arthritis caused by Listeria monocytogenes is a exceptional event. We report a new case of prosthetic knee arthritis due to Listeria in a woman with seropositive rheumatoid arthritis and Waldenström’s macroglobulinemia receiving prednisone and methotrexate. In addition, we review the literature on listeria joint infections

Condromatosis sinovial. Estudio de 39 pacientes / Synovial chondromatosis. A study of 39 patients

Objetivo: Estudiar las manifestaciones clínicas, el empleo de las técnicas de diagnóstico por la imagen y la evolución de las condromatosis sinoviales en nuestra área sanitaria. Pacientes y métodos: El hospital POVISA tiene vinculada una población de 127.000 habitantes. Se revisaron retrospectivamente las historias clínicas de todos los pacientes de nuestra área sanitaria en los que se estableció histológicamente el diagnóstico de condromatosis sinovial entre enero de 1992 y diciembre de 2003. Resultados: Se recogieron 38 condromatosis de localización articular, todas monoarticulares, y 1 extraarticular, que correspondieron a 20 varones y a 19 mujeres, cuya edad (media ± DE) en el momento del diagnóstico fue de 56,5 ± 12,7 años (rango: 16-79 años). La principal localización articular fue la rodilla (15; 39,5%), seguida de la cadera (8; 21%) y de la temporomandibular y codo, ambas en 3 (7,9%) pacientes. Se documentó una artropatía previa en 18 (18/38; 47,4%) pacientes. El período sintomático previo al diagnóstico fue de 25,4 ± 34 meses. Las manifestaciones clínicas más frecuentes fueron el dolor articular (100%), la restricción de la movilidad (77%) y la tumefacción (57%). Se realizaron radiografías simples en todos los pacientes y sugirieron el diagnóstico en 20 (51,3%) de ellos. Los hallazgos de la resonancia magnética orientaron al diagnóstico en 12 (80%) de los 15 pacientes en los que se solicitó. En todos los casos se procedió a la extracción de los cuerpos libres y a una sinovectomía que se realizó por vía artroscópica en 6. Fue necesario colocar una prótesis articular (cadera o rodilla) en 16 (42%) pacientes. Durante el seguimiento posquirúrgico (23,7 ± 5,3 meses) no se identificó ningún caso de condrosarcoma y la tasa de recidivas fue baja (7,9%). Conclusiones: En nuestro medio, casi la mitad (47,4%) de las condromatosis sinoviales asentaron sobre una articulación previamente dañada, la demora del diagnóstico superó los 2 años y fue necesaria una prótesis de cadera o rodilla en el 42% de los pacientes(AU)

Objective: To study the clinical manifestations, use of diagnostic imaging techniques and outcome of patients with synovial chondromatosis in our health area. Patients and methods: POVISA Hospital provides health services to a population of 127,000 inhabitants. The clinical histories of all the patients in this area who were histologically diagnosed with synovial chondromatosis between January 1992 and December 2003 were reviewed. Results: There were 38 cases of joint chondromatosis, all monoarticular, and one case of extra-articular chondromatosis in 20 men and 19 women aged 56.5 ± 12.7 years (mean ± SD) at diagnosis (range: 16-79 years). The main joint affected was the knee (15; 39.5%), followed by the hip (8; 21%) and the temporomandibular joint and elbow, both of these in three patients (7.9%). Previous arthropathy was recorded in 18 patients (18/38, 47.4%). Symptom duration prior to diagnosis was 25.4 ± 34 months. The most frequent clinical manifestations were joint pain (100%), restricted movement (77%) and swelling (57%). Plain radiographs were carried out in all patients and suggested the diagnosis in 20 (51.3%). Magnetic resonance imaging findings led to a diagnosis in 12 out of 15 patients in whom this procedure was required (80%). In all patients loose bodies were removed and synovectomy was performed by arthroscopic procedures in six. In 16 patients (42%) total joint replacement was required. The mean postoperative follow-up was 23.7 ± 5.3 months. No cases of chondrosarcoma were identified and the recurrence rate was low (7.9%). Conclusions: In our setting, almost half (47.4%) of the cases of synovial chondromatosis occurred in a previously damaged joint: the correct diagnosis was delayed by more than 2 years and total arthroplasty was required in 42% of the patients(AU)

[Pyomyositis, sacroiliitis and spondylodiscitis caused by Staphylococcus hominis in a immunocompetent woman]. / Piomiositis, sacroiliitis y espondilodiscitis por Staphylococcus hominis en una mujer sin compromiso inmune.

In absence of risk factors, osteoarticular infections by coagulase-negative staphylococci are very infrequent. We described the case of a immunocompetent 73-year-old-woman that suffered pyomyositis, left sacroiliitis and spondylodiscitis involving the first and second thoracic vertebrae by Staphylococcus hominis. This multifocal infection occurred five-weeks after intramuscular administration of NSAI for treatment of low back pain associated with a herniated disc L4-L5. This is the first know case of a multifocal muscle skeletal infection by Staphylococcus hominis in a patient immunocompetent.

[Synovial chondromatosis. A study of 39 patients]. / Condromatosis sinovial. Estudio de 39 pacientes.

OBJECTIVE: To study the clinical manifestations, use of diagnostic imaging techniques and outcome of patients with synovial chondromatosis in our health area. PATIENTS AND METHODS: POVISA Hospital provides health services to a population of 127,000 inhabitants. The clinical histories of all the patients in this area who were histologically diagnosed with synovial chondromatosis between January 1992 and December 2003 were reviewed. RESULTS: There were 38 cases of joint chondromatosis, all monoarticular, and one case of extra-articular chondromatosis in 20 men and 19 women aged 56.5±12.7 years (mean±SD) at diagnosis (range: 16-79 years). The main joint affected was the knee (15; 39.5%), followed by the hip (8; 21%) and the temporomandibular joint and elbow, both of these in three patients (7.9%). Previous arthropathy was recorded in 18 patients (18/38, 47.4%). Symptom duration prior to diagnosis was 25.4±34 months. The most frequent clinical manifestations were joint pain (100%), restricted movement (77%) and swelling (57%). Plain radiographs were carried out in all patients and suggested the diagnosis in 20 (51.3%). Magnetic resonance imaging findings led to a diagnosis in 12 out of 15 patients in whom this procedure was required (80%). In all patients loose bodies were removed and synovectomy was performed by arthroscopic procedures in six. In 16 patients (42%) total joint replacement was required. The mean postoperative follow-up was 23.7±5.3 months. No cases of chondrosarcoma were identified and the recurrence rate was low (7.9%). CONCLUSIONS: In our setting, almost half (47.4%) of the cases of synovial chondromatosis occurred in a previously damaged joint: the correct diagnosis was delayed by more than 2 years and total arthroplasty was required in 42% of the patients.

Artritis séptica por Escherichia coli en una mujer con artropatía gotosa / Escherichia coli septic artritis in a woman with gout

No disponible

Dermatomiositis en una paciente con artritis reumatoide tratada con leflunomida / Development of dermatomyositis in a woman with rheumatoid arthritis treated with leflunomide

No disponible

Enfermedad de Erdheim-Chester e histiocitosis de células de Langerhans. ¿Una asociación fortuita? / Erdheim-Chester disease and Langerhans histiocytosis. A fortuitous association?

La enfermedad de Erdheim-Chester es una histiocitosis sistémica de origen desconocido, histológicamente distinta de la histiocitosis de células de Langerhans, que se caracteriza por lesiones óseas esclerosantes de distribución simétrica, con predominio en las diáfisis y metáfisis de huesos largos. No está clasificada dentro de las histiocitosis malignas, no obstante, su curso clínico suele ser agresivo, con escasa respuesta a los diversos tratamientos ensayados. Excepcionalmente, se han descrito casos con hallazgos anatomopatológicos de la enfermedad de ErdheimChester asociados a la presencia de histiocitos de Langerhans. Presentamos un nuevo paciente en el que se identificaron cambios radiográficos compatibles con enfermedad de Erdheim-Chester pero cuyo estudio histológico mostró una histiocitosis de células de Langerhans y cursó con ostealgias, mialgias, diabetes insípida, exoftalmos, lesiones óseas esclerosantes bilaterales y simétricas así como un síndrome cerebeloso (AU)

[Infectious spondylodiscitis in a health area of Galicia (Spain) from 1983-2003]. / Espondilodiscitis infecciosas en un área sanitaria gallega, 1983-2003.

OBJECTIVE: To study the clinical-epidemiological characteristics of infectious spondylodiscitis (IS) in adults of our health area in the late 20 years. MATERIAL AND METHODS: We performed a retrospective analysis of the medical records of adult patients with a diagnosis of both, tuberculous (TS) and non tuberculous spondylodiscitis (NTS), between January 1983 and December 2003. The diagnosis was made when compatible clinical-radiological picture were present in association with at least two positive blood cultures and/or micro-organism recovery from vertebral samples. Additionally, TS was diagnosed when biopsy showed typical caseating granulomas from vertebral or extra-vertebral lesions. RESULTS: 17 TS and 22 NTS were identified. The mean age was lower in patients with TS than in NTS (43.5 +/- 24.6 vs 52.0 +/- 15.2 years; mean +/- SD). Patients were predominantly males in both, TS (57%) and NTS (82%; p < 0001). The time between the onset of symptoms and diagnosis was longer in TS (16.4 +/- 15.2 weeks) than in NTS (3.9 +/- 3.2 weeks), p= 0.005. Seven (41%) of the 17 patients with TS had active extra-vertebral tuberculosis. A source of infection was presumed in 20 NTS (90%), mainly surgical spinal procedures (9/22.41%). In three TS and four NTS one o more predisposing factors were observed. The patients with NTS presented a higher prevalence of fever (41 vs 24%; p= 0.0003) and leucocytosis (41 vs 12%; p < 0.001), but less neurological impairment (9 vs 21% p= 0,01). None patient with NTS presented mixed infection and Staphylococcus aureus was the main pathogen (14/22.64%) follows by Streptococcus sp (6/22.27%). Klebsiella pneumoniae and Proteus mirabilis were the remain causative agents. Spinal cord decompression and surgical drainage of abscess were performed in five patients (24%) with TS and four patients with NTS (18%), p= 0.0027). Neurological sequels were more common in the patients with TS (24 vs 14%, p= 0.008). The global incidence of IS was 2.2 cases/105 inhabitants/year, which 1.73 cases are NTS. CONCLUSIONS: The IS are a unusual disease what occurs predominantly in male patients. In the last 10 years, a increasing prevalence of NTS was observed, with high contribution (41%) of post-surgical cases. Diagnostic delay is greater in patients with TS and this condition was associated with more neurological sequels.