Assuntos
Antibacterianos/uso terapêutico , Artralgia/tratamento farmacológico , Artrocentese/efeitos adversos , Sedação Consciente/efeitos adversos , Intubação Intratraqueal , Ketamina/efeitos adversos , Edema Pulmonar/induzido quimicamente , Doença Aguda , Anestésicos Dissociativos/administração & dosagem , Anestésicos Dissociativos/efeitos adversos , Artralgia/etiologia , Artrocentese/métodos , Reanimação Cardiopulmonar , Cefazolina/uso terapêutico , Comorbidade , Sedação Consciente/métodos , Doença da Artéria Coronariana , Diabetes Mellitus Tipo 2 , Doxiciclina/uso terapêutico , Feminino , Gota , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipertensão , Ketamina/administração & dosagem , Pessoa de Meia-Idade , Edema Pulmonar/complicações , Edema Pulmonar/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Sepse/tratamento farmacológico , Articulação do Punho/microbiologia , Articulação do Punho/patologiaRESUMO
We report a rare case of multifocal septic arthritis associated to spondylodiscitis and endocarditis caused by group A beta-hemolytic streptococcus (GABHS) in an immunocompetent adult, and we discuss diagnosis and therapeutic difficulties, while insisting into the rational use of corticosteroids that seems to be the only risk factor in our patient.
Assuntos
Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Artrite/diagnóstico , Artrite/microbiologia , Imunocompetência , Infecções Estreptocócicas/complicações , Streptococcus pyogenes , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Artrite/tratamento farmacológico , Artrite Infecciosa/tratamento farmacológico , Humanos , Articulação do Joelho/microbiologia , Vértebras Lombares/microbiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento , Articulação do Punho/microbiologiaRESUMO
Cutaneous mucormycosis, a relatively common infection in immunocompromised patients, remains rare in the immunocompetent patient outside the setting of major trauma. We report a case of an immunocompetent patient who developed left upper extremity Rhizopus infection following arterial puncture. Treatment included surgical debridement, liposomal amphotericin B, and hyperbaric oxygen wound therapy; the patient recovered fully. A review of the literature of cases of upper extremity Mucor infection is included for context. We feel that a high degree of suspicion for Mucor infection is warranted in patients with the described risk factors who do not respond to first-line antibiotics.
Assuntos
Mucormicose/terapia , Punções/efeitos adversos , Rhizopus , Dermatopatias Infecciosas/terapia , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Artéria Braquial/cirurgia , Terapia Combinada , Desbridamento , Endarterectomia/efeitos adversos , Feminino , Humanos , Oxigenoterapia Hiperbárica , Imunocompetência , Lipossomos , Pessoa de Meia-Idade , Mucormicose/imunologia , Dermatopatias Infecciosas/imunologia , Dermatopatias Infecciosas/microbiologia , Transplante de Pele , Articulação do Punho/microbiologiaRESUMO
A 60-year-old woman with rheumatoid arthritis, who had been treated with infliximab, presented with uncontrollable wrist arthritis. Fungal arthritis caused by Candida parapsilosis was confirmed by examining her aspirated joint fluid. Her infliximab therapy was interrupted, and antifungal therapy with fluconazole was started. After the fungal infection had been ameliorated, surgical debridement and arthrodesis of the wrist joint were conducted, and her symptoms completely resolved. Although fungal arthritis is rare, it should be considered as a differential diagnosis of exacerbated monoarthritis in patients treated with biological agents.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Infecciosa/microbiologia , Artrite Reumatoide/tratamento farmacológico , Candida/isolamento & purificação , Candidíase/tratamento farmacológico , Articulação do Punho/microbiologia , Antifúngicos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/cirurgia , Candidíase/cirurgia , Desbridamento , Feminino , Fluconazol/uso terapêutico , Humanos , Infliximab , Pessoa de Meia-Idade , Articulação do Punho/cirurgiaRESUMO
BACKGROUND: Kingella kingae (Kk) is frequently responsible for invasive skeletal infections in children aged 3-36months. However, few outbreaks of invasive Kk infections in day care centers have been reported. The objective of the present study was to describe (a) the clinical and laboratory data recorded during an outbreak of invasive Kk skeletal infections, and (b) the management of the outbreak. METHOD: Four children from the same day care center were included in the study May and June 2019. We retrospectively analyzed the children's clinical presentation and their radiological and laboratory data. We also identified all the disease control measures taken in the day care center. RESULTS: We observed cases of septic arthritis of the wrist (case #1), shoulder arthritis (case #2), knee arthritis (case #3) ans cervical spondylodiscitis (case #4). All cases presented with an oropharyngeal infection and concomitant fever prior to diagnosis of the skeletal infection. All cases were misdiagnosed at the initial presentation. The mean (range) age at diagnosis was 10.75months (9-12). The three patients with arthritis received surgical treatment. All patients received intravenous and then oral antibiotics. In cases 1 and 2, Kk was detected using real-time PCR and a ST25-rtxA1 clone was identified. The outcome was good in all four cases. Four other children in the day care center presented with scabies during this period and were treated with systemic ivermectin. The Regional Health Agency was informed, and all the parents of children attending the day care center received an information letter. The day care center was cleaned extensively. CONCLUSION: Our results highlight the variety of features of invasive skeletal Kk infections in children and (given the high risk of transmission in day care centers) the importance of diagnosing cases as soon as possible.
Assuntos
Artrite Infecciosa/epidemiologia , Creches , Discite/epidemiologia , Surtos de Doenças/prevenção & controle , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/epidemiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Artrite Infecciosa/transmissão , Vértebras Cervicais/microbiologia , Pré-Escolar , Terapia Combinada , Diagnóstico Diferencial , Discite/diagnóstico , Discite/microbiologia , Discite/terapia , Feminino , França/epidemiologia , Humanos , Articulação do Joelho/microbiologia , Masculino , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/terapia , Infecções por Neisseriaceae/transmissão , Estudos Retrospectivos , Articulação do Ombro/microbiologia , Articulação do Punho/microbiologiaRESUMO
Tumor necrosis factor (TNF) is a cytokine associated with the pathogenesis of rheumatoid arthritis. Tumor necrosis factor inhibitors have become important biological treatments that favorably alter the natural history of rheumatoid disease. Side effects include an increased risk of malignancy and infection, particularly tuberculosis. We present 2 patients with rheumatoid arthritis on TNF inhibitors in whom flares of wrist tenosynovitis, initially diagnosed as rheumatoid disease exacerbations, were caused by infections with uncommon opportunistic pathogens. Diagnostic and treatment recommendations for this subset of rheumatoid patients are discussed.
Assuntos
Artrite Reumatoide/complicações , Infecções por Mycobacterium/complicações , Infecções Oportunistas/complicações , Tenossinovite/complicações , Tenossinovite/microbiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Articulação do Punho/microbiologia , Idoso , Artrite Reumatoide/tratamento farmacológico , Desbridamento , Progressão da Doença , Feminino , Humanos , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Transferência Tendinosa , Tenossinovite/cirurgia , Resultado do TratamentoRESUMO
Infections in the joints of the hand and wrist carry the risk of significant morbidity. Common presenting symptoms include joint redness, swelling, and pseudoparalysis that occurs several days following a penetrating trauma. Diagnostic workup should be expedited, including a laboratory evaluation and arthrocentesis. Imaging, including radiographs, ultrasound, computed tomography, and/or MRI, are helpful tools in diagnosis. Once infection is identified, prompt surgical debridement and antibiotics are required. Once the infection has been managed, hand therapy is initiated to decrease the risk of stiffness. Stiffness is the most common complication following infection; additional reported complications include arthritis, ankylosis, and amputation."
Assuntos
Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Articulações dos Dedos/microbiologia , Articulação do Punho/microbiologia , Algoritmos , Antibacterianos/uso terapêutico , Artroscopia , Desbridamento , Drenagem , Articulações dos Dedos/cirurgia , Humanos , Hospedeiro Imunocomprometido , Articulação do Punho/cirurgiaRESUMO
Septic arthritis of the wrist can result in joint destruction, making timely diagnosis crucial for initiating empiric antibiotics and surgical intervention. Mycobacterium is a rare cause of this disorder. A 47-year-old man with bladder cancer was treated surgically and received BCG intravesical therapy. Eleven months later, this patient developed severe carpal BCGitis requiring total carpal resection. The first step was addition of a cement spacer and radiometacarpal stabilisation (Masquelet technique). Secondary infections occurred aggravating the prognosis. This case emphasises the importance of taking into account the patient's medical history. Tuberculosis of the wrist is a rare etiology for septic arthritis; delayed treatment leads to severe complications and functional sequelae.
Assuntos
Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Vacina BCG/efeitos adversos , Tuberculose Osteoarticular/terapia , Articulação do Punho/microbiologia , Antibióticos Antituberculose/uso terapêutico , Ossos do Carpo/cirurgia , Etambutol/uso terapêutico , Humanos , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mycobacterium bovis/isolamento & purificação , Rifampina/uso terapêutico , Retalhos Cirúrgicos , Sinovectomia , Tuberculose Osteoarticular/etiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Articulação do Punho/cirurgiaRESUMO
CASE: An adult woman with anti-aminoacyl-t RNA synthetase syndrome developed pain and swelling of both hands and her left forearm, initially diagnosed as seronegative rheumatoid arthritis. Surgical exploration revealed multiple "rice bodies," and the specimen grew Mycobacterium intracellurale. She subsequently received antibiotic therapy. CONCLUSION: In the diagnosis of rice body formation in musculoskeletal tissues, it is necessary to consider not only rheumatic diseases but also mycobacterial infection.
Assuntos
Aminoacil-tRNA Sintetases/imunologia , Dermatomiosite/complicações , Infecções por Mycobacterium não Tuberculosas/patologia , Articulação do Punho/patologia , Idoso , Desbridamento , Dermatomiosite/imunologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/cirurgia , Complexo Mycobacterium avium/isolamento & purificação , Ultrassonografia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/microbiologiaRESUMO
Osteoarticular tuberculosis is the third most frequent location of tuberculosis after the lung and lymph nodes, accounting for approximately 10%-20% of all cases of extrapulmonary disease. Tuberculosis of the hand and wrist is the rarest osteoarticular location after the shoulder. The authors report the case of a 50-year-old woman without medical history who was diagnosed with isolated tuberculosis of the wrist presenting as monarthritis. The diagnosis was confirmed by histopathological and microbiological examination. Late stages of osteomyelitis are even rarer without any predisposing factors such as immunosuppression. This case underlines the importance of including tuberculosis in the differential diagnosis of monoarthritic syndromes to prevent delayed initiation of therapy and consequent complications and bone damage.
Assuntos
Artrite/diagnóstico , Tuberculose Osteoarticular/diagnóstico , Articulação do Punho/diagnóstico por imagem , Antituberculosos/uso terapêutico , Artralgia/diagnóstico por imagem , Artralgia/tratamento farmacológico , Artralgia/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose Osteoarticular/tratamento farmacológico , Tuberculose Osteoarticular/patologia , Articulação do Punho/microbiologiaRESUMO
We present the case of a 73-year old patient suffering from chronic flexor tendon synovitis of the wrist with carpal tunnel syndrome. He underwent synovectomy and median nerve release. Primary bacteriology was negative. Histology of the excised synovia revelead non-caseating granuloma as typical for sarcoidosis. Further screening for sarcoidosis was negative. Culture of a sample harvested from the poorly healing wound was finally positive for Mycobacterium tuberculosis. Tuberculostatic treatment was started and the wound gradually healed. To the best of our knowledge, this is the first reported case of atypical non-caseating and sarcoidosis-like granulomas of the flexor tendon synovia of the hand as first manifestation of tuberculosis.
Assuntos
Sinovite/diagnóstico , Tendões/patologia , Tuberculose Osteoarticular/diagnóstico , Articulação do Punho/patologia , Idoso , Síndrome do Túnel Carpal/diagnóstico , Doença Crônica , Diagnóstico Diferencial , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Sarcoidose/diagnóstico , Sinovite/microbiologia , Tendões/microbiologia , Tuberculoma/diagnóstico , Articulação do Punho/microbiologiaRESUMO
Tuberculosis (TB) is still endemic in many developing countries. Involvement of wrist joint is very rare, and the diagnosis is often missed. We present a case of isolated TB of the wrist, which was confirmed with intraosseous tissue histopathological examination in a 10-year-old boy. Antibacterial chemotherapy during 12 months promoted healing and good outcome.
Assuntos
Tuberculose Osteoarticular/microbiologia , Articulação do Punho/microbiologia , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Criança , Humanos , Masculino , Tuberculose Osteoarticular/diagnóstico , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/patologiaRESUMO
Skeletal tuberculosis (TB) of the hand and wrist is rare, accounting for less than 1% of all osteoarticular TB. Although rare, TB of the hand and wrist is a cause of major morbidity. A common feature among all available reports on TB of the hand and wrist was a delay in diagnosis, causing residual stiffness and pain after treatment. Minimal initial symptoms, rarity of the lesion and ability of wrist TB to mimic more common pathologies account for the delay. Skeletal TB may behave differently in this age compared with the adult population. Further, the disease may affect the growing bone, causing residual deformities. The paucity of studies from different countries, coupled with a difficulty in diagnosis resulting in major morbidity, led us to carry out a study on this topic. A total of 44 patients with skeletal lesions in the hand and wrist were studied. The diagnosis was confirmed by biopsy. Patients were started on multidrug antitubercular treatment (ATT). Those not responding were scheduled for debridement. All patients were assessed using the Green O'Brian scoring system. All these patients were studied separately for clinical presentation, nutritional status (Rainey-Mcdonald nutritional index), time from onset of symptoms to presentation, treatment required, prognosis and complications. The proximal phalanx of the fourth digit and the metacarpal of the fifth digit were the most commonly involved bones in our series, with five cases of each. The capitate was the most common carpal bone, followed by the lunate. The duration of symptoms ranged from 5 weeks to 24 weeks (mean: 7.6 weeks). Most of these patients presented with complaints of pain, followed by swelling. 13 patients did not respond favourably to ATT over an 8-week period and were scheduled for surgery. Three of these patients had multidrug resistance. There was one case of a pathological fracture in our series and seven cases of arthritis/residual significant pain at the end of follow-up. For all the other patients, the results were excellent. A very high index of suspicion, MRI and early biopsy are required for a timely diagnosis of skeletal TB of the hand and wrist. Early commencement of ATT was the most important factor for good results. The possibility of multidrug resistance should be kept in mind for patients not responding to treatment.
Assuntos
Antituberculosos/uso terapêutico , Mãos/microbiologia , Tuberculose Osteoarticular/tratamento farmacológico , Articulação do Punho/microbiologia , Punho/microbiologia , Adolescente , Biópsia , Ossos do Carpo/microbiologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Ossos Metacarpais/microbiologia , Fatores de Tempo , Tuberculose Osteoarticular/diagnóstico por imagemRESUMO
Atypical mycobacterial and fungal infections may occur in immunosuppressed patients. The impaired host response can make the clinical presentation atypical. Blood and tissue cultures may be negative in the acute phase of the illness, which can lead to a delay in diagnosis. In those patients with AIDS or other underlying immunosuppressive conditions, histoplasmosis cannot always be eradicated, but treatment that achieves chronic suppression may be adequate to maintain functional capacity. This report describes two immunosuppressed patients who presented with isolated subcutaneous histoplasmosis infection around the wrist.
Assuntos
Histoplasmose/diagnóstico , Hospedeiro Imunocomprometido , Artropatias/microbiologia , Articulação do Punho/microbiologia , Adulto , Idoso , Diabetes Mellitus Tipo 1/imunologia , Infecções por HIV/imunologia , Hepatite C Crônica/imunologia , Humanos , MasculinoRESUMO
The tuberculosis of the hand and the wrist is a rare entity. Affecting the scapholunate joint is exceptional. It is usually diagnosed at an advanced stage of carpal destruction, due to slowly development of the symptoms. We report the case of a 58-year-old female, presenting as wrist pain for 3 months. Clinical study showed a local swelling in the left wrist, the mobility of the wrist was normal but painful at the end of motion. The diagnosis of osteoarticular tuberculosis was suspected after radiological and biological study then confirmed after histological study. Antibacillary chemotherapy during 12 months promoted healing and good outcome.
Assuntos
Tuberculose Osteoarticular/diagnóstico , Articulação do Punho/microbiologia , Antituberculosos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Tuberculose Osteoarticular/tratamento farmacológico , Tuberculose Osteoarticular/microbiologia , Tuberculose Osteoarticular/fisiopatologia , Articulação do Punho/fisiopatologiaRESUMO
The superior soft tissue contrast and multiplanar capability of MR imaging has contributed to earlier diagnosis and implementation of effective treatment for a variety of arthropathies and infectious conditions of the elbow, wrist, and hand. Because of overlapping clinical signs and symptoms, MR imaging plays an important role in delineating the features and staging of each of these conditions. This article discusses the seropositive and seronegative inflammatory arthropathies, with emphasis on early detection and surveillance, as well as gout, synovial osteochondromatosis, pigmented villonodular synovitis, tenosynovitis, and de Quervain's tenosynovitis. Certain noninflammatory arthritides and infectious conditions are also reviewed.
Assuntos
Articulação do Cotovelo/patologia , Mãos/patologia , Artropatias/diagnóstico , Imageamento por Ressonância Magnética , Articulação do Punho/patologia , Infecções Bacterianas/diagnóstico , Doenças Ósseas/diagnóstico , Doenças Ósseas/microbiologia , Articulação do Cotovelo/microbiologia , Mãos/microbiologia , Humanos , Artropatias/microbiologia , Articulação do Punho/microbiologiaRESUMO
A 27-year-old man, who had been shoveling gravel in southern Texas for 3 years, had a history of papules and nodules in the left lateral wall of the abdomen. The lesions increased in number and severity with spread to other regions of the body. A punch biopsy of the right arm lesion revealed intracellular, round and cigar shaped budding yeast. The cultures grew Sporotrichum schenkii. Three-phase bone imaging and a Ga-67 scan defined the extent of the disease including involvement of the right tibia, left second metacarpal, and the left wrist joints, the latter two of which were not apparent on clinical examination.
Assuntos
Osso e Ossos/diagnóstico por imagem , Osteomielite/diagnóstico por imagem , Esporotricose/diagnóstico por imagem , Adulto , Radioisótopos de Gálio , Humanos , Artropatias/diagnóstico por imagem , Artropatias/microbiologia , Masculino , Osteomielite/microbiologia , Cintilografia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/microbiologiaRESUMO
INTRODUCTION: The objective of the case report is to highlight the possibility of osteomyelitis caused by atypical mycobacteria. Such an infection may simulate tuberculous bone infection and yet fail to respond to standard anti-tuberculous drug therapy. CLINICAL PICTURE: A 66-year-old man who suffered from diabetes mellitus presented with osteomyelitis of the right wrist, with extensive synovial swellings of the flexor tendon sheaths. The clinical features, radiological appearances and histology suggested a tuberculous infection, but subsequent culture grew an atypical mycobacterium, Mycobacterium scrofulaceum. TREATMENT AND OUTCOME: There was good clinical improvement and control of the infection with a regime of kanamycin, ethambutol and ethionamide to which the organism was sensitive. CONCLUSION: This case illustrates the need to be aware of the possibility of infection with atypical mycobacteria in cases of suspected tuberculosis of the skeletal system which fail to respond to standard treatment.