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Nocardia cyriacigeorgica pneumonia in ulcerative colitis patient receiving infliximab despite TMP/SMX prophylaxis 尽管有TMP/SMX预防，但接受英夫利昔单抗治疗的溃疡性结肠炎患者中的cyriacigorgica诺卡菌肺炎

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.184

Dharma Sunjaya * , Jennifer Toy , Seth Sweetser

Introduction

Infliximab is an effective therapy for induction and maintenance of remission in patients with refractory ulcerative colitis (UC). Treatment with TNF-alpha inhibitors is associated with an increased risk of infection. In this case, we will discuss an uncommon cause of infection associated with infliximab therapy despite antibiotic prophylaxis.

Case description

78-year-old man with history of UC maintained on infliximab infusion every 8-weeks was found to have pulmonary infiltrates on chest computed tomography (CT). His UC history was notable for recent Pneumocystis jiroveci pneumonia while on infliximab requiring intravenous Trimethoprim/Sulfamethoxazole (TMP/SMX) treatment for 21 days followed by single strength oral TMP/SMX for secondary prophylaxis. On evaluation, the patient endorsed weakness, generalized fatigue, and shortness of breath with activities. His lab was notable for mild anemia in the absence of leukocytosis.

Result and conclusion

Bronchoscopy was performed and bronchoalveolar lavage fluid was sent to the microbiology laboratory for culture. After 30 days of incubation, the culture returned partially acid fast, branching, Gram-positive rod shaped bacteria consistent with Nocardia cyriacigeorgica. The isolate was susceptible to TMP/SMX (0.25/4.75μg/Ml). Patient was started on therapeutic dose of oral TMP/SMX at 5 mg/kg of the trimethoprim component for 6 months. Infliximab was subsequently held. Repeat chest CT scan at 6 months showed resolution of patchy ground glass and nodular infiltrates.

Take-home message

This case highlights the importance of considering Nocardia infection in ulcerative colitis patients receiving infliximab therapy presenting with shortness of breath and new infiltrates on chest imaging. In addition, patients receiving prophylaxis with TMP/SMX are still at risk for this infection because the effectiveness of prophylactic doses of TMP/SMX in preventing disease remains unclear.

英夫利昔单抗是一种诱导和维持难治性溃疡性结肠炎(UC)缓解的有效疗法。使用tnf - α抑制剂治疗与感染风险增加有关。在这种情况下，我们将讨论一个不常见的感染原因与英夫利昔单抗治疗，尽管抗生素预防。病例描述78岁男性，有UC病史，每8周输注一次英夫利昔单抗，胸部计算机断层扫描(CT)发现肺部浸润。他的UC病史值得注意的是最近的肺孢子虫肺炎，同时使用英夫利昔单抗，需要静脉注射甲氧苄氨嘧啶/磺胺甲恶唑(TMP/SMX)治疗21天，然后口服单剂量TMP/SMX进行二级预防。经评估，患者承认虚弱，全身疲劳，呼吸短促与活动。他的实验室在没有白细胞增多的情况下发现了轻度贫血。结果与结论行支气管镜检查，支气管肺泡灌洗液送微生物实验室培养。培养30天后，培养物部分返回耐酸、分枝、革兰氏阳性杆状菌，与cyriacigorgica诺卡菌一致。菌株对TMP/SMX敏感(0.25/4.75μg/Ml)。患者开始口服TMP/SMX治疗剂量，剂量为5mg /kg的甲氧苄啶成分，为期6个月。英夫利昔单抗随后被扣留。6个月复查胸部CT，可见斑片状磨玻璃及结节性浸润。本病例强调了在接受英夫利昔单抗治疗的溃疡性结肠炎患者中考虑诺卡菌感染的重要性，这些患者在胸部影像学上表现为呼吸短促和新的浸润。此外，由于预防性剂量的TMP/SMX在预防疾病方面的有效性尚不清楚，接受TMP/SMX预防性治疗的患者仍然面临这种感染的风险。

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引用次数: 0

Partial Priapisim: A rare presentation of sickle cell anemia 镰状细胞性贫血的一种罕见表现

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.156

Mariam Malallah * , Hussain Al Rashed , Abdullatif Al Terki , Tariq Al Shaiji

Introduction

Partial segmental thrombosis of the corpus cavernosum (PSTCC); known as partial priapism; is an uncommon urological condition which predominantly affects young men in which the proximal part of one corpus cavernosum is thrombosed. Many risk factors are described in the literature, the exact etiology of penile thrombosis and its pathogenesis remains unclear. Several treatment options are available ranging from conservative medical treatment with NSAIDs, antibiotics, analgesics, low molecular weight heparin, acetylsalicylic acid and antibiotics, surgical or to a follow-up observation without treatment. In this study we presented a sickle cell patient who presented with pain and perineal swelling and diagnosed with PSTCC using MRI and was treated conservatively.

Case description

A 23-year-old male, known case of sickle cell anemia, presented to casualty with a 1-day history of perineal pain of a sudden onset, increasing in severity, no aggravating or relieving factors. It was associated with perineal swelling, decrease in urine output and vomiting, not associated with urethral discharge, erectile dysfunction, trauma, sexual contact, fever, abdominal pain, lower urinary tract symptoms, change in bowel habits, or bleeding per rectum. He had a past history of left pyeloplasty in childhood. He was a smoker, non-alcohol consumer with a family history of liver malignancy. Examination revealed a stable vitals, abdomen was soft and non-tender, genitourinary exam findings confirmed the absence of priapism. There was a normal circumcised penis, normal bilateral testis and epididymis, separated perineal mass slightly hard in consistency, fixed and tender at the proximal part of the penis. Digital rectal examination was unremarkable. The complete blood count showed mild leukocytosis, electrolytes, coagulation profile, urine analysis and urine culture were unremarkable. MRI perineal and penis showed the right intratunical corpus cavernosum with altered signal intensity involving the root, proximal and mid third sparing the distal third of corpus cavernosum, maximum width of 26mm (predominantly hyposignal intensity with few areas of hypersignal intensity). Visualized Buck’s fascia and tunica albuginea were intact. Features mostly suggestive of right corpus cavernosum hematoma. Conservative treatment was initiated with 6 hourly IV paracetamol and the response was observed with gradually disappearing pain, reduction in swelling size and leukocytic count. On follow up patient was pain free, reduction in swelling size with a recovery of painless erection. A follow up ultrasound of the scrotum and a hematologist referral were arranged.

Results and conclusions

PSTCC is not an urological crisis and has an excellent prognosis. Conservative treatment appears to be a reliable therapeutic option. Surgery is reserved for patients in whom conservative management fails.

海绵体部分节段性血栓形成;被称为部分阴茎勃起;是一种罕见的泌尿系统疾病，主要影响年轻男性，其中一个海绵体近端形成血栓。文献中描述了许多危险因素，但阴茎血栓形成的确切病因及其发病机制尚不清楚。有几种治疗选择，包括非甾体抗炎药、抗生素、镇痛药、低分子肝素、乙酰水杨酸和抗生素的保守治疗、手术或不治疗的随访观察。在这项研究中，我们报告了一位镰状细胞患者，他表现为疼痛和会阴肿胀，并通过MRI诊断为PSTCC，并进行了保守治疗。病例描述:一名23岁男性，镰状细胞性贫血，就诊时有1天突然发作的会阴疼痛史，疼痛程度逐渐加重，无加重或缓解因素。它与会阴肿胀、尿量减少和呕吐有关，与尿道分泌物、勃起功能障碍、创伤、性接触、发热、腹痛、下尿路症状、排便习惯改变或直肠出血无关。儿童时期有左侧肾盂成形术病史。他吸烟，不喝酒，有肝脏恶性肿瘤家族史。检查显示生命体征稳定，腹部柔软无触痛，泌尿生殖系统检查证实无勃起。阴茎包皮环切正常，双侧睾丸及附睾正常，会阴肿块分离，粘稠度稍硬，阴茎近端固定压痛。直肠指检无明显异常。全血细胞计数显示轻度白细胞增多，电解质、凝血、尿分析和尿培养无明显变化。会阴及阴茎MRI示右侧管内海绵体，信号强度改变累及海绵体根、近端及中端三分之一，保留海绵体远端三分之一，最大宽度26mm(以低信号为主，少数高信号区)。可见巴克筋膜和白膜完好无损。特征多提示右侧海绵体血肿。保守治疗开始6小时静脉注射扑热息痛，观察到疼痛逐渐消失，肿胀大小和白细胞计数减少。随访患者无疼痛，肿胀大小减少，无痛勃起恢复。安排了阴囊超声检查和血液科医生转诊。结果与结论spstcc不是泌尿系统危象，预后良好。保守治疗似乎是一种可靠的治疗选择。手术只适用于保守治疗失败的病人。

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引用次数: 0

Physical plasma in palliative cancer care: Introduction and perspectives 物理血浆在姑息性癌症治疗:介绍和观点

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.200

C. Seebauer, S. Kindler, T. Woedtke, H. Metelmann

引用次数: 1

Marcus Gunn Syndrome and implications for Oral and Maxillofacial surgery (OMFS) Marcus Gunn综合征及其对口腔颌面外科(OMFS)的影响

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.143

Claire Graham * , Nathalie Gallichan , Katharine Fleming , Kathryn Taylor

Introduction

Marcus Gunn Syndrome, also known as Jaw Wink Syndrome or trigemino-oculomotor synkinesis, was first reported in 1883. It typically presents at birth with unilateral ptosis and eyelid elevation on jaw opening. Pathophysiology is explained by an oculofacial synkinesis. There is an aberrant connection of the oculomotor nerve and the mandibular branch of the trigeminal nerve resulting in eyelid elevation on mouth opening. The typically congenital syndrome is exceptionally rare. It is often diagnosed in infancy with complete ophthalmic examination and ptosis evaluation. This syndrome does not often require surgical intervention but it may still have an impact in clinical management.

Case description

A 32-year-old male presented in the OMFS outpatient clinic in Countess of Chester Hospital for extraction of his lower third molars. His past medical history included a known diagnosis of Marcus Gunn Syndrome but he was otherwise fit and well. He had resting ptosis of the left and elevation of the left eyelid on jaw protrusion.

Results and conclusions

Third molars were removed uneventfully under local anesthesia and no further treatment was required. Literature suggests that patients with Marcus Gunn Syndrome may have an atypical oculocardiac reflex during their surgical procedure and patients are at increased risk of malignant hypothermia. In this case, the procedure was performed under local anesthesia but this condition may impact on surgical planning if general anesthesia was to be considered.

marcus Gunn综合征，也被称为下颌眨眼综合征或三叉-动眼病联动症，于1883年首次报道。它通常表现为出生时单侧上睑下垂和下颌开口的眼睑抬高。病理生理学是通过眼面联动来解释的。动眼神经与三叉神经下颌支的异常连接导致开口时眼睑升高。这种典型的先天性综合症非常罕见。通常在婴儿期通过完整的眼科检查和上睑下垂评估来诊断。这种综合征通常不需要手术干预，但它仍可能对临床管理产生影响。病例描述一名32岁男性在切斯特伯爵夫人医院的OMFS门诊进行下三磨牙的拔除。他过去的病史包括一个已知的马库斯·冈恩综合症的诊断，但他其他方面都很健康。左侧静息性上睑下垂，左侧眼睑上凸，下颌突出。结果与结论本组第三磨牙在局部麻醉下顺利拔除，无需进一步治疗。文献表明，Marcus Gunn综合征患者在手术过程中可能出现非典型心眼反射，患者发生恶性低体温的风险增加。在本例中，手术是在局部麻醉下进行的，但如果要考虑全身麻醉，这种情况可能会影响手术计划。

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引用次数: 0

Right sided reconstruction of the heart for invasive angiosarcoma of the right atrium 侵袭性右心房血管肉瘤的右侧心脏重建

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.161

E. Brouwers, M. Herregods, E. Verbeken, P. Herijgers, W. Oosterlinck

引用次数: 1

Return to Pre-Injury Level of Sport in an Elite Age-Group Triathlete after Non-Operative Treatment of Combined Complete Obturator Internus and Partial Hamstring Tendon Tears 一名优秀年龄组铁人三项运动员在非手术治疗完全性闭孔内肌和部分腘绳肌腱撕裂后恢复到损伤前的运动水平

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.201

T. Greenhalgh, Adnan Saithna, K. Iyengar, S. Ramteke

引用次数: 0

Usefulness of repetitive transcranial magnetic stimulation for the recovery of central cord syndrome 重复经颅磁刺激对中枢脊髓综合征恢复的作用

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.177

Jung Keun Hyun *, Seo Young Kim, Tae Uk Kim

Objectives

Repetitive transcranial magnetic stimulation (rTMS) can modulate neuronal circuits and also enhance spinal cord plasticity. Our aim of this study was to delineate the effect of rTMS on the functional recovery of upper extremity in patients with incomplete spinal cord injury, especially central cord syndrome (CCS), and detect the changes of spinal cord tracts crossing the lesion by diffusion tensor imaging (DTI).

Method

Fourteen patients with CCS, which level of injury was between C4 to C6, were performed rTMS with high frequency (20Hz) over the unilateral motor cortex for 5 days as well as the conventional occupational therapy. The non-treated side of each subject was used as control. We assessed the neurological status using International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI), and functional status of upper extremities using the Jebsen hand function and O'conner finger dexterity tests twice; before treatment, and 1 month after treatment. DTI was performed on the injured cervical spinal cord, obtained fractional anisotrophy (FA), apparent diffusion coefficient (ADC) at each level, and calculate imaginary spinal cord tracts of each subject.

Results

The neurological status of the upper extremity motor score in the treated side using ISNCSCI was improved in all subjects otherwise only 10 of 14 subjects (71.4%) showed some improvements of non-treated side at 1 month after treatment. The functional status including the writing score of Jebsen hand function test were also significantly improved more in treated side in comparison with non-treated side at 1 month. The FA values and the number of imaginary spinal cord tracts of treated side at the injured level were also increased more than those of non-treated side in the same subjects. Any side effects such as seizure, severe headache, nausea or vision problem was not observed during rTMS treatment and follow-up period.

Conclusions

The high frequency rTMS was effective to improve the neurological and functional status of CCS patients and might increase the spinal cord plasticity without any serious side effects.

目的反复经颅磁刺激(rTMS)可以调节神经回路，增强脊髓可塑性。本研究旨在探讨rTMS对不完全性脊髓损伤，特别是中枢脊髓综合征(CCS)患者上肢功能恢复的影响，并通过弥散张量成像(DTI)检测脊髓束穿过病变的变化。方法对14例损伤程度在C4 ~ C6之间的CCS患者，在常规职业治疗的基础上，对其单侧运动皮质进行高频(20Hz) rTMS治疗5 d。每个受试者的未治疗侧作为对照。我们使用国际脊髓损伤神经学分类标准(ISNCSCI)评估神经系统状态，并使用捷成手功能和O'conner手指灵巧度测试两次评估上肢功能状态;治疗前、治疗后1个月。对损伤后的颈脊髓行DTI，得到各水平的各向异性分数(FA)和表观扩散系数(ADC)，并计算每个受试者的假想脊髓束。结果ISNCSCI治疗侧上肢运动评分在治疗1个月后得到改善，而非治疗侧只有10例(71.4%)出现改善。治疗侧患者的功能状态包括捷成手功能测试写作评分在1个月时也较未治疗侧显著改善。治疗侧损伤水平的FA值和假想脊髓束数也明显高于未治疗侧。在rTMS治疗和随访期间未观察到任何副作用，如癫痫发作、严重头痛、恶心或视力问题。结论高频rTMS能有效改善CCS患者的神经功能状况，增加脊髓可塑性，无严重副作用。

{"title":"Usefulness of repetitive transcranial magnetic stimulation for the recovery of central cord syndrome","authors":"Jung Keun Hyun *, Seo Young Kim, Tae Uk Kim","doi":"10.1016/j.nhccr.2017.06.177","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.177","url":null,"abstract":"<div><h3>Objectives</h3><p>Repetitive transcranial magnetic stimulation (rTMS) can modulate neuronal circuits and also enhance spinal cord plasticity. Our aim of this study was to delineate the effect of rTMS on the functional recovery of upper extremity in patients with incomplete spinal cord injury, especially central cord syndrome (CCS), and detect the changes of spinal cord tracts crossing the lesion by diffusion tensor imaging (DTI).</p></div><div><h3>Method</h3><p>Fourteen patients with CCS, which level of injury was between C4 to C6, were performed rTMS with high frequency (20Hz) over the unilateral motor cortex for 5 days as well as the conventional occupational therapy. The non-treated side of each subject was used as control. We assessed the neurological status using International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI), and functional status of upper extremities using the Jebsen hand function and O'conner finger dexterity tests twice; before treatment, and 1 month after treatment. DTI was performed on the injured cervical spinal cord, obtained fractional anisotrophy (FA), apparent diffusion coefficient (ADC) at each level, and calculate imaginary spinal cord tracts of each subject.</p></div><div><h3>Results</h3><p>The neurological status of the upper extremity motor score in the treated side using ISNCSCI was improved in all subjects otherwise only 10 of 14 subjects (71.4%) showed some improvements of non-treated side at 1 month after treatment. The functional status including the writing score of Jebsen hand function test were also significantly improved more in treated side in comparison with non-treated side at 1 month. The FA values and the number of imaginary spinal cord tracts of treated side at the injured level were also increased more than those of non-treated side in the same subjects. Any side effects such as seizure, severe headache, nausea or vision problem was not observed during rTMS treatment and follow-up period.</p></div><div><h3>Conclusions</h3><p>The high frequency rTMS was effective to improve the neurological and functional status of CCS patients and might increase the spinal cord plasticity without any serious side effects.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Pages 18-19"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Physical plasma in palliative cancer care: Introduction and perspectives 物理血浆在姑息性癌症治疗:介绍和观点

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.200

Christian Seebauer * , Stefan Kindler , Thomas von Woedtke , Hans-Robert Metelmann

Background

Patients suffering from advanced head and neck tumors frequently suffer from superinfected chronic wounds caused by necrotic tissue due to progressive tumor growth, weak systemic and local immunological response and various accompanying illnesses. Due to strong wound vulnerability, local antiseptic wound care of microbial contaminated tumor areas is frequently complicated by bleeding, pain and patient dissatisfaction. As Cold Atmospheric Plasma (CAP) has been proven to be anti-microbial and anti-cancerous, CAP could occupy an important role in palliative cancer care.

Material and methods

After a curably intended surgical cancer treatment of a well-differentiated squamous cell carcinoma of the left cheek at the beginning of 2015, the 51-year-old patient noticed a rapidly progressive swelling on the left neck in June. CT scan indicated a large contrast enhancing mass, which was suspected to be tumor recurrence. Operative findings revealed inoperability due to infiltrating the vascular wall of the external carotid. After a palliative intended combined radio-chemotherapy, the tumor was characterized by progressive growth with exulceration. Due to the vulnerability of the extended bacterially contaminated wound and the underlying carotid artery, wound care was difficult. Since October, a supportive palliative cancer treatment using CAP has been started with the patients' written consent. The exulcerative tumor growth region received treatment with the kINPenMED (Neoplas GmbH, Greifswald, Germany) for near 5 minutes in a meandering manner. Plasma treatment was continued to be performed every 3 days. Wound care was implemented in conjunction with an antiseptic wound dressing.

Results

The superinfected necrotic tumor areas appeared to be clean of cell detritus and bacteria. Microbiological examination revealed a reduction of bacterial colonization which led to decrease of wound odour, too. Due to the decrease of inflammation, vulnerability and wound algesia have been reduced significantly. Upon CAP therapy a partial tumor response with tumor mass reduction were observed. The ulcerated tumor area has been reduced to one-quarter of its original size. The underlying carotid artery is still intact and ultrasound investigation revealed a regular blood flow. Histological examinations revealed an increased amount of apoptotic tumor cells and a local increase of immune defense. Furthermore, a desmoplastic reaction of the conjunctive tissue represented by a higher proliferation rate of fibroblasts could be depicted. No plasma relevant systemic side effects have occurred.

Conclusion

By a sufficient reduction of bacterial colonization, decrease of inflammation, wound vulnerability and algesia, CAP constitutes an innovative and valuable treatment option in palliative cancer care. Local tumor mass reduction is an unexpected and promising response during CAP treatment

研究背景晚期头颈部肿瘤患者由于肿瘤的进展性生长、全身和局部免疫反应弱以及各种伴随疾病，经常出现由坏死组织引起的慢性伤口超感染。微生物污染肿瘤区由于伤口的高度易损性，局部消毒创面护理往往伴随着出血、疼痛和患者的不满意。低温大气等离子体(Cold Atmospheric Plasma, CAP)已被证实具有抗微生物和抗癌的作用，在姑息性癌症治疗中具有重要的应用价值。材料和方法2015年初，51岁的患者接受了左侧脸颊分化良好的鳞状细胞癌的手术治疗，6月，患者发现左侧颈部出现快速进行性肿胀。CT示一较大增强肿块，怀疑肿瘤复发。手术结果显示因浸润颈外动脉血管壁而无法手术。在姑息性放化疗联合治疗后，肿瘤表现为进行性生长伴溃烂。由于延伸性细菌污染创面及其下颈动脉的易损，创面护理困难。自10月以来，在患者的书面同意下，一项使用CAP的支持性姑息性癌症治疗已经开始。溃疡性肿瘤生长区域接受kINPenMED (Neoplas GmbH, Greifswald, Germany)迂回治疗近5分钟。继续每3天进行一次血浆治疗。伤口护理与消毒伤口敷料一起实施。结果重复感染的坏死肿瘤区无细胞碎屑和细菌。微生物学检查显示细菌定植减少，导致伤口气味减少。由于炎症的减少，易损性和伤口疼痛明显减少。经CAP治疗后，观察到部分肿瘤反应，肿瘤体积减小。溃烂的肿瘤面积缩小到原来的四分之一。颈动脉下方仍完好无损，超声检查显示血流正常。组织学检查显示肿瘤细胞凋亡增加，局部免疫防御增强。此外，结缔组织的结缔组织增生反应以成纤维细胞的高增殖率为代表。未发生血浆相关的全身副作用。结论CAP可充分减少细菌定植，减少炎症、伤口易感性和疼痛感，是癌症姑息治疗中一种创新和有价值的治疗选择。在CAP治疗中，局部肿瘤肿块的减少是一种意想不到的、有希望的反应，需要进一步研究。

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引用次数: 1

Unusual presentation of tuberculous meningitis: Two case reports 结核性脑膜炎的不寻常表现:两例报告

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.164

Shafa Kadhim Tlayib *, Zainab Abdelramman, Fawzia Munir

Introduction

Central nervous system tuberculosis is a serious health problem worldwide and accounts for more than 7% of all cases of tuberculosis especially in developing countries with high prevalence of tuberculosis and also should be considered in high risk patients or in patient emigrated from regions with a high prevalence of tuberculosis. Tuberculous radiculomylitis is a complication of tuberculous meningitis which has been infrequently reported in medical literature.

Case description

Case I: A 49-year-old previously healthy Filipino female with 5 days history of fever, back pain radiating to both legs followed by acute onset of lower limb weakness and urine retention one day prior to presentation. Physical examination revealed pyrexia, alert patient, no sign of meningeal irritation and lower limb power decrease (3/5) normal exam of upper limb. Investigation showed elevated WBC in Cerebral Spinal Fluid (60% lymphocyte). Positive PPD and positive quantiferon test. MRI showed extensive enhancement around nerve roots extending cranially to lower thoracic. Patient started on antituberculous treatment, steroid and physiotherapy. Six month post treatment did not show significant neurological improvement, but fever respond after start of treatment.

Case II: A 27-year-old healthy Filipino female, presented with history of fever, headache, neck and back pain with vomiting, three weeks prior to presentation and was treated as case of otitis media with two different antibiotic given during two primary health care visits. Presented with one day lower abdominal pain with urinary retention and body weakness. Physical exam showed lethargic patient afebrile with spastic quadriparesis power of upper limb 4/5 and lower limb 3/5. Investigation showed cerebrospinal fluid, high WBC (90% lymphocyte), high CSF protein and low glucose. High serum ESR. MRI showed increase leptomeningeal enhancement of spinal cord extending to the pons. Patient also started on steroid and antituberclous drugs. Patient made good clinical recovery and discharged.

Results and conclusions

In patient with tuberculous meningitis, an early diagnosis and initiation of therapy plays a major role in preventing unnecessary morbidity and mortality. In several series, use of the steroid has been considered beneficial and should be given for secondary neurological complications, associated with tuberculous meningitis. Emergency clinician must be aware of unusual presentation of tuberculous meningitis and other different causes of lower limb weakness. Neuroimaging with MRI with and without contrast and lumber puncture is critical for diagnosis.

中枢神经系统结核病是世界范围内严重的健康问题，占所有结核病病例的7%以上，特别是在结核病高流行的发展中国家，也应考虑高风险患者或从结核病高流行地区移民的患者。结核性根性脊髓炎是结核性脑膜炎的一种并发症，在医学文献中很少报道。病例1:49岁既往健康的菲律宾女性，发热5天，腰痛辐射至双腿，随后出现急性下肢无力和尿潴留，发病前1天。体格检查显示发热，患者清醒，无脑膜刺激征象，下肢力量下降(3/5)，上肢检查正常。调查显示脑脊液白细胞升高(60%淋巴细胞)。PPD阳性，定量子试验阳性。MRI显示神经根周围广泛强化，从颅脑延伸至下胸椎。患者开始抗结核治疗，类固醇和物理治疗。治疗后6个月未见明显的神经系统改善，但治疗开始后有发热反应。病例二:一名27岁的健康菲律宾女性，在发病前三周出现发热、头痛、颈部和背部疼痛并呕吐的病史，在两次初级卫生保健就诊期间作为中耳炎病例接受了两种不同的抗生素治疗。表现为下腹疼痛，伴尿潴留及身体虚弱一天。体格检查显示患者嗜睡无热，伴有痉挛性四肢瘫，上肢功率为4/5，下肢功率为3/5。检查显示脑脊液，白细胞高(90%淋巴细胞)，脑脊液蛋白高，低糖。血清ESR高。MRI显示脊髓轻脑膜增强，延伸至脑桥。患者同时开始服用类固醇和抗结核药物。患者临床恢复良好，出院。结果与结论结核性脑膜炎的早期诊断和早期治疗对预防不必要的发病和死亡起着重要作用。在几个系列中，类固醇的使用被认为是有益的，并且应该给予与结核性脑膜炎相关的继发性神经系统并发症。急诊临床医生必须意识到结核性脑膜炎的不寻常表现和其他不同的下肢无力的原因。神经影像学与MRI有或没有对比和腰椎穿刺是诊断的关键。

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引用次数: 0

Implantation of Penile Prosthesis (3-piece Inflatable) for Erectile Dysfucntion in a Patient with Left Orchiectomy for Left Undescended Testis: A Cosmetic Approach 植入阴茎假体(3片充气)治疗左睾丸切除术患者的勃起功能障碍:一种美容方法

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.183

Ahmad Al-Tawari, Said M. Yaiesh, Tariq F. Al-Shaiji

引用次数: 0

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