Ankylosing hyperostosis of the spine is described as osteophytic spurs or anterior osseous bridges with thickening of the corresponding vertebral cortex. The ossification includes the ligamentum longitudinale anterius and the peripheral part of the disc. Our patient had minor complaints but at the time of consultation was symptomatic.
One important conclusion should be made. When a laparoscopy or laparotomy is done, one should take full advantage of this by inspecting and/or palpating the second tube, the ovaries, and most pelvic and abdominal structures. Incidental diagnosis may prove to be at times as important as the one for which the surgery is being done.
In summary, rheumatic fever seems to be on the rise in the United States. It remains to be seen whether this case is an example of a resurgence of ARF in adults in Virginia, but it probably does, since there are a number of cases being seen in the pediatric population.
Ehrlichiosis is a disease that should be considered in any case of chills, fever and malaise, with or without a history of tick bites.
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