Case 269: Sacroiliac Joint Hydatid Disease.

HistoryA 20-year old woman living in Turkey presented with a 3-month history of lower back pain. She had no medical history of note and was taking no medications. Complete blood count, C-reactive protein level, sedimentation rate, and creatinine, alanine aminotransferase, and aspartate aminotransferase levels were within normal limits. Anteroposterior pelvic radiography and unenhanced pelvic CT were performed to rule out sacroiliitis. The imaging findings were abnormal, and the patient underwent contrast-enhanced sacroiliac MRI. A few days later, she underwent contrast-enhanced (100 mL iohexol, Omnipaque; GE Healthcare, Cork, Ireland) abdominal CT because of right upper quadrant pain.

Unusual Location of Hydatid Cysts: Report of Two Cases in the Heart and Hip Joint of Romanian Patients.

Hydatid cyst is usually located in the liver and lungs, rare cases showing localization in other organs or tissues. In the unusual location, echinococcosis is an excluding diagnosis that is established only after microscopic evaluation. Our first case occurred in a 67-year-old female previously diagnosed with pulmonary tuberculosis and hospitalized with persistent pain in the hip joint. The clinical diagnosis was tuberculosis of the joint, but the presence of the specific acellular membrane indicated a hydatid cyst of the synovial membrane, without bone involvement. Fewer than 25 cases of joint hydatidosis have been reported in literature to date. In the second case, the intramural hydatid cyst was incidentally discovered at autopsy, in the left heart ventricle of a 52-year-old male hospitalized for a fatal brain hemorrhage, as a result of rupture of an anterior communicating artery aneurysm. The conclusion of our paper is that echinococcosis should be taken into account for the differential diagnosis of cystic lesions, independently from their location.

[Hydatidosis: apropos of several uncommon locations]. / Hydatidose: à propos de quelques localisations inhabituelles.

Most hydatid cysts are found in the liver or lungs but occurrence in other locations is possible. The purpose of this report is to describe three cases involving cysts locate in the ovary, joint, and thyroid. Clinical findings associated with these uncommon locations were poorly specific and diagnosis required histological examination after surgical exploration. Imaging and serology were useful to differentiate hydatid cyst from benign or malignant tumor disease but often failed to achieve definitive differential diagnosis. Thorough investigation is necessary to rule out more common locations in the liver or lung. Continued surveillance is needed for early detection of recurrence. Preventive campaigns are necessary in endemic areas, such as Morocco.

Filariasis of the ankle: magnetic resonance imaging.

Filariasis is a world health problem that is frequently seen in tropical and subtropical countries. In endemic areas, the clinical spectrum of extremity swelling, lymphangitis, or elephantiasis is usually recognized as filariasis. In the United States, diagnosis of the disease may be more difficult because of lack of familiarity with this infection. We present a case of filaremic arthropathy of the ankle joint and the magnetic resonance imaging (MRI) findings of this disease. It is the first reported case of MRI findings in a human patient. MRI has been done on animal models with filariasis, and the findings are similar.

Filariasis of the ankle: magnetic resonance imaging

Filariasis is a world health problem that is frequently seen in tropical and subtropical countries. In endemic areas, the clinical spectrum of extremity swelling, lymphangitis, or elephantiasis is usually recognized as filariasis. In the United States, diagnosis of the disease may be more difficult because of lack of familiarity with this infection. We present a case of filaremic anthropathy of the ankle joint and the magnetic resonance imaging (MRI) findings of this disease. It is the first reported case of MRI findings in a human patient. MRI has been done on animal models with filariasis, and the findings are similar. (AU)

Hydatid disease of bones and joints. 8 cases followed for 4-16 years.

Hydatid disease is a rare parasitic disease that seldom involves the skeleton. Treatment is difficult because of problems with the preoperative diagnosis, the invasive nature of the bony involvement and the variable anaphylactic reaction to the cyst fluid antigen. We present 8 cases with osseous hydatidosis who were treated over a period of 11 years. The spine was involved in 2 cases, the ilium in 2, the hip in 2, the tibia in 1 and the humerus in 1. We point out that diagnosis is difficult and the prognosis is often poor.

Hydatid disease of bone with adjacent joint involvement. A radiological follow-up of 12 years.

Osseous lesions have been reported in only 1-2% of patients with hydatid disease. Joint involvement is usually due to secondary extension from the adjacent bone, although primary hydatid synovitis after haematogenous spread of the infection can be seen. We present a long-term radiological follow-up (12 yr) in a patient who developed hydatid disease of the left pelvic and femoral bones with cartilage destruction of the ipsilateral hip joint. After a Girdlestone arthroplasty, she received mebendazole (3 g/day) for 10 yr and albendazole (400 mg/day) for 2 yr with radiological impairment of the lesions. Complete surgical excision is the treatment of choice for osseous hydatid disease. Isolated medical therapy with mebendazole or albendazole is not adequate for controlling the process, but it can be added to surgery or, as in our case, used like isolated therapy when complete excision is not possible.

Emergence of unusual opportunistic pathogens in AIDS: a review.

Opportunistic infections are a major cause of morbidity and death among patients infected with the human immunodeficiency virus (HIV), particularly late in the disease, when immunosuppression is severe. Some pathogens, such as Pneumocystis carinii and Toxoplasma gondii, are extremely common in this population and are readily recognized by clinicians caring for these patients. However, many other organisms occasionally cause conditions that clinically mimic the more commonly encountered pathogens. Clinicians must be alert to the threat posed by these less frequently occurring organisms and of the broader differential diagnosis that must be considered for infections in patients with HIV infection.

Onchocerciasis in Malawi. 2. Subjective complaints and decreased weight in persons infected with Onchocerca volvulus in the Thyolo highlands.

In the course of an onchocerciasis survey in southern Malawi, body weight was recorded for 10,335 persons aged 20 years and older, and the body mass index was calculated for 5572. A history of symptomatic complaints was elicited from 5653 persons 20 years of age and older. Persons with microfilariae in the skin snips weighed significantly less than persons with negative skin snips. Symptomatic complaints of musculoskeletal pains, itching, dizziness and poor vision were reported more commonly in the group with microfilariae. These findings suggest that onchocerciasis should no longer be considered a disease affecting the eye and skin only but an infection which produces systemic effects as well. Systemic effects of onchocerciasis may lessen productivity of an endemic region by a process distinct from the effects of visual impairment.

Case report 629: Osseous hydatidosis.

In summary, hydatidosis is a common infection that infrequently involves the skeleton. When this happens the prognosis is uncertain because of the possible extension of the disease and serious complications, (e.g., pathological fractures, visceral involvement, neurologic damage from vertebral involvement). For this reason, simple curettage is not sufficient for cure and no medical treatment can surely eradicate the disease. Hydatidosis, in our opinion, should be staged and surgically treated like a malignant tumor (e.g., with wide surgical margins). Medical treatment is useful in association with surgery and remains the only therapy for inoperable lesions. A case of echinococcosis of the hip joint in a 37-year-old man has been reported. In this case the clinicoradiographical features suggested pigmented villonodular synovitis. Proof was obtained on the basis of a frozen section on biopsy. The clinical and laboratory characteristics of hydatidosis were discussed, with emphasis on the medical and surgical treatment of the disorder.