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SAPHO Syndrome Wikbooks
Definition
Synovitis
Acne -- commonly involving the face and upper back.
Pustulosis -- usually involving the palms of the hands and/or soles of the feet (palmo-plantar pustulosis).
Hyperostosis
Osteitis
SAPHO syndrome is thought to comprise a spectrum of disorders that share some clinical, radiologic and pathologic characteristics. An entity known as chronic recurrent multifocal osteomyelitis (CRMO) was first described in 1972. Subsequently in 1978 several cases of CRMO were associated with clinical findings of palmoplantar pustulosis. Since then, a number of associations between skin conditions and osteoarticular disorders have been reported with a variety of different names including sternocostoclavicular hyperostosis, pustulotic arthro-osteitis, and acne-associated spondyloarthropathy. SAPHO was coined in 1987 and basically represents a spectrum of inflammatory osteitis which may or may not be associated with dermatologic pathology.
Diagnostic Radiology/Musculoskeletal Imaging/Infection/SAPHO Syndrome
From Wikibooks, the open-content textbooks collection
SAPHO Syndrome Wikipedia
SAPHO syndrome is thought to comprise a spectrum of disorders that share some clinical, radiologic and pathologic characteristics. An entity known as chronic recurrent multifocal osteomyelitis (CRMO) was first described in 1972. Subsequently in 1978 several cases of CRMO were associated with clinical findings of palmoplantar pustulosis. Since then, a number of associations between skin conditions and osteoarticular disorders have been reported with a variety of different names including sternocostoclavicular hyperostosis, pustulotic arthro-osteitis, and acne-associated spondyloarthropathy. SAPHO was coined in 1987 and basically represents a spectrum of inflammatory osteitis which may or may not be associated with dermatologic pathology.
Definition
Synovitis
Acne -- commonly involving the face and upper back.
Pustulosis -- usually involving the palms of the hands and/or soles of the feet (palmo-plantar pustulosis).
Hyperostosis
Osteitis
Staphylococcus Aureus Infections eMedicine Pediatrics
Article by Tolan et al 2007
Contents - Introduction; Clinical; Differentials; Workup; Treatment; Medication; Follow-up; Miscellaneous; References
Contents - Introduction; Clinical; Differentials; Workup; Treatment; Medication; Follow-up; Miscellaneous; References
Subacute Osteomyelitis Brodie Abscess eMedicine Orthopedics
Authors: Khalid Khoshhal & Mervyn Letts
Subacute osteomyelitis is a distinct form of osteomyelitis, and Brodie abscess is one type of subacute osteomyelitis. Subacute osteomyelitis is difficult to diagnose because the characteristic signs and symptoms of the acute form of the disease are absent. It has an insidious onset, mild symptoms, and lacks a systemic reaction, and supportive laboratory data are inconsistent. Subacute osteomyelitis may mimic various benign and malignant conditions, resulting in delayed diagnosis and treatment. The most frequently made incorrect diagnosis is that of tumor.
Subacute osteomyelitis is a distinct form of osteomyelitis, and Brodie abscess is one type of subacute osteomyelitis. Subacute osteomyelitis is difficult to diagnose because the characteristic signs and symptoms of the acute form of the disease are absent. It has an insidious onset, mild symptoms, and lacks a systemic reaction, and supportive laboratory data are inconsistent. Subacute osteomyelitis may mimic various benign and malignant conditions, resulting in delayed diagnosis and treatment. The most frequently made incorrect diagnosis is that of tumor.
Surgical Strategies For Vertebral Osteomyelitis And Epidural Abscess
From Neurosurgical Focus
Surgical Strategies for Vertebral Osteomyelitis and Epidural Abscess
Posted 01/07/2005 Neurosurg Focus 17(6), 2004
Patrick C. Hsieh, M.D.; Robert J. Wienecke, M.D.; Brian A. O'Shaughnessy, M.D.; Tyler R. Koski, M.D.; Stephen L. Ondra, M.D. Abstract Pyogenic vertebral discitis and osteomyelitis (PVDO) has become an increasing problem for the spine surgeon. Despite recent advances in medical care and improved diagnostic neuroimaging, PVDO remains a major cause of illness and death in the elderly population. Infection of the spinal column often presents insidiously; however, if not treated appropriately and in a timely manner it can lead to severe neurological impairment, systemic septicemia, and progressive spinal deformity. In this paper the authors review the epidemiological and pathophysiological features and the clinical presentation of PVDO. Conventional medical therapy is described, with a particular focus on the methods of diagnosis. Surgical strategies for PVDO are then presented based on the literature and according to the practice of the senior author (S.L.O.), with an emphasis placed on structural considerations, implant selection, and techniques for augmenting vascular tissue to the site of infection.
Patrick C. Hsieh, M.D.; Robert J. Wienecke, M.D.; Brian A. O'Shaughnessy, M.D.; Tyler R. Koski, M.D.; Stephen L. Ondra, M.D. Abstract Pyogenic vertebral discitis and osteomyelitis (PVDO) has become an increasing problem for the spine surgeon. Despite recent advances in medical care and improved diagnostic neuroimaging, PVDO remains a major cause of illness and death in the elderly population. Infection of the spinal column often presents insidiously; however, if not treated appropriately and in a timely manner it can lead to severe neurological impairment, systemic septicemia, and progressive spinal deformity. In this paper the authors review the epidemiological and pathophysiological features and the clinical presentation of PVDO. Conventional medical therapy is described, with a particular focus on the methods of diagnosis. Surgical strategies for PVDO are then presented based on the literature and according to the practice of the senior author (S.L.O.), with an emphasis placed on structural considerations, implant selection, and techniques for augmenting vascular tissue to the site of infection.
Treatment Of A Chronic Scedosporium Apiospermum Vertebral Osteomyelitis Medscape
Case Report
Neurosurg Focus 17(6), 2004 Posted 01/18/2005
John W. German, M.D.; Susan M. Kellie, M.D.; Manjunath P. Pai, Pharm.Dc.; Paul T. Turner, M.D.
Scedosporium apiospermum is a rare cause of fungal vertebral osteomyelitis that may result in chronic infection requiring multiple surgical interventions and long-term medical therapy. This case is the seventh one reported in the literature and is the first to include salvage surgery of a previous major spinal reconstruction. This report is also the first to describe the use of the new antifungal agent voriconazole. In treating this case of chronic vertebral osteomyelitis, several principles are emphasized from both the surgical and medical perspectives. From a surgical perspective, the use of salvage surgery, temporary avoidance of spinal instrumentation, and an appropriate choice of graft materials are emphasized. From a medical perspective, confirmation of the diagnosis, the need for long-term antifungal therapy, the need for long-term patient compliance, and the use of the new antifungal agent voriconazole are emphasized. Application of these principles has led to an adequate 2-year outcome.
Scedosporium apiospermum is a rare cause of fungal vertebral osteomyelitis that may result in chronic infection requiring multiple surgical interventions and long-term medical therapy. This case is the seventh one reported in the literature and is the first to include salvage surgery of a previous major spinal reconstruction. This report is also the first to describe the use of the new antifungal agent voriconazole. In treating this case of chronic vertebral osteomyelitis, several principles are emphasized from both the surgical and medical perspectives. From a surgical perspective, the use of salvage surgery, temporary avoidance of spinal instrumentation, and an appropriate choice of graft materials are emphasized. From a medical perspective, confirmation of the diagnosis, the need for long-term antifungal therapy, the need for long-term patient compliance, and the use of the new antifungal agent voriconazole are emphasized. Application of these principles has led to an adequate 2-year outcome.
Tuberculosis
Radiology case 462-23 Clinical presentation:
Swelling and discomfort in the left ankle in an adult male from India.
Tuberculosis knee
Radiology case 458-23 Clinical presentation:
Gradual onset of pain and swelling in the left knee in a 30 year old man, originally from India.
Unusual presentation of shoulder joint
Journal of Orthopaedic Surgery 2001, 9(1): 57–60 Jitendra Mangwani, Anil Kumar Gupta, CS Yadav and KS Rao
Central Institute of Orthopaedics, Safdarjang Hospital,New Delhi, India
ABSTRACT Tuberculosis of the shoulder joint is uncommon. In adults the classical dry type of shoulder tuberculosis (caries sicca) has been described, while the fulminating variety has not been reported. We treated a case of fulminating variety of tuberculosis of the shoulder joint with anti-tubercular therapy and a shoulder immobilizer sling. At 18 months of follow up, the patient was disease free and had a good functional range of motion.
ABSTRACT Tuberculosis of the shoulder joint is uncommon. In adults the classical dry type of shoulder tuberculosis (caries sicca) has been described, while the fulminating variety has not been reported. We treated a case of fulminating variety of tuberculosis of the shoulder joint with anti-tubercular therapy and a shoulder immobilizer sling. At 18 months of follow up, the patient was disease free and had a good functional range of motion.
Use of antibiotic-loaded polymethyl methacrylate beads in the management of musculoskeletal sepsis - a retrospective study
Journal of Orthopaedic Surgery 2003: 11(1): 73–79
SP Mohanty, MN Kumar, NS Murthy
Department of Orthopaedics, Kasturba Medical College, Manipal 576 119, Karnataka, India
ABSTRACT Purpose. To assess the use of antibiotic-loaded polymethyl methacrylate beads in the management of chronic osteomyelitis of different aetiologies: in- fected osteosynthesis, infected open fractures, and haematogenous osteomyelitis. Methods. Records of 49 patients with chronic osteomyelitis who were treated at Department of Orthopaedics, Kasturba Medical College, from 1995 to 1999 were studied retrospectively. The diagnosis of chronic osteomyelitis was made on the basis of clinical and radiographic features. Of the 49 patients, 4 had haematogenous osteomyelitis, which later proved to be tuberculosis, and were thus excluded. Antibiotic- loaded acrylic beads were implanted in the remaining patients after thorough debridement. The implant was removed primarily in 16 patients with infected osteosynthesis, who then underwent decompression and sequestrectomy. All wounds were closed primarily. Peri-operative antibiotics were given for 7 days. Beads were removed at the end of 3 weeks followed by bone grafting in 26 patients. Patients were followed up for an average period of 3.7 years. Results. The infective organisms were sensitive to gentamycin in 26 cases and resistant in 19 cases; 14 cases were sensitive to cefuroxime, 11 to cloxacillin, 8 to ampicillin, and 5 to cotrimoxazole. Seven cases were resistant to all antibiotics tested. Of the 19 patients with gentamycin-resistant infection, only one had a poor result. No adverse systemic side-effects such as ototoxicity or nephrotoxicity were seen. Infection did not recur in 39 patients, but 6 patients had low-grade persistent infection at the last follow-up visit. Conclusion. In chronic infections, especially those following osteosynthesis, antibiotic beads are a valuable adjuvant. The most valuable advantage is that the wound can be closed primarily, thereby reducing the incidence of nosocomial infections and requirement of nursing care.
ABSTRACT Purpose. To assess the use of antibiotic-loaded polymethyl methacrylate beads in the management of chronic osteomyelitis of different aetiologies: in- fected osteosynthesis, infected open fractures, and haematogenous osteomyelitis. Methods. Records of 49 patients with chronic osteomyelitis who were treated at Department of Orthopaedics, Kasturba Medical College, from 1995 to 1999 were studied retrospectively. The diagnosis of chronic osteomyelitis was made on the basis of clinical and radiographic features. Of the 49 patients, 4 had haematogenous osteomyelitis, which later proved to be tuberculosis, and were thus excluded. Antibiotic- loaded acrylic beads were implanted in the remaining patients after thorough debridement. The implant was removed primarily in 16 patients with infected osteosynthesis, who then underwent decompression and sequestrectomy. All wounds were closed primarily. Peri-operative antibiotics were given for 7 days. Beads were removed at the end of 3 weeks followed by bone grafting in 26 patients. Patients were followed up for an average period of 3.7 years. Results. The infective organisms were sensitive to gentamycin in 26 cases and resistant in 19 cases; 14 cases were sensitive to cefuroxime, 11 to cloxacillin, 8 to ampicillin, and 5 to cotrimoxazole. Seven cases were resistant to all antibiotics tested. Of the 19 patients with gentamycin-resistant infection, only one had a poor result. No adverse systemic side-effects such as ototoxicity or nephrotoxicity were seen. Infection did not recur in 39 patients, but 6 patients had low-grade persistent infection at the last follow-up visit. Conclusion. In chronic infections, especially those following osteosynthesis, antibiotic beads are a valuable adjuvant. The most valuable advantage is that the wound can be closed primarily, thereby reducing the incidence of nosocomial infections and requirement of nursing care.
