Chronic encephalitis caused by leukoencephalopathy

Article Abstract:

Progressive multifocal leukoencephalopathy (PML), first identified in 1958, is a rare disease that destroys the myelin sheath surrounding the nerves of the central nervous system. Several other demyelinating diseases, including multiple sclerosis (MS), have very similar symptoms, making diagnosis difficult. The case of a 43-year-old woman with mental and physiological symptoms is presented, and the steps in making a differential diagnosis between MS and PML are detailed. PML most often occurs with other diseases or therapies that compromise the immune system, such as AIDS, Hodgkin's disease, tuberculosis, chronic lymphatic leukemia, systemic lupus erythematosus, and rheumatoid arthritis, and in patients receiving immunosuppressive drugs. It is caused by the normally benign JC virus, present in most older adults. The incidence has increased in the past decade because it occurs in almost four percent of those with the AIDS virus. PML, which usually occurs in those in the fifties and sixties, causes death within six months to several years, although remissions have been reported. Initial symptoms include speech and vision difficulties, numbness, lack of coordination, and mental deterioration. As the disease progresses, dementia, blindness, paralysis, and breathing problems occur. The cause of MS is unknown, and it usually strikes people in their thirties and forties, primarily in the northern latitudes. Mental deterioration and speech problems are uncommon early in MS (although mood changes and depression are common), but in PML they are often the first symptoms. The presence of cancer, granular tumors, weight loss, digestive problems, and immune system abnormalities point to a diagnosis of PML. A careful history, laboratory findings and magnetic resonance imaging (MRI) can also differentiate between the two diseases. Although both diseases are progressive, a seesaw pattern of symptoms and remissions is more common with MS. There is no treatment for MS, but steroids and immunosuppressant drugs have helped in some cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Autoimmune diseases, Cancer, Multiple sclerosis, AIDS (Disease), Leukoencephalopathy, Progressive multifocal, Progressive multifocal leukoencephalopathy

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Pseudomonas stutzeri synthetic vascular graft infection

Article Abstract:

A 61-year-old woman with a seven-year history of coronary artery disease was seen for abdominal pain. A pulsatile mass was noted on the left side of her abdomen, and a diagnosis of aortic aneurysm (a ballooning of the wall of the main systemic artery, the aorta) was made. The patient underwent surgery to replace a segment of her aorta with a synthetic Gore-Tex graft. The patient received treatment with an antibiotic, cefazolin sodium, before and after surgery. Her recovery was marred by the formation of vascular clots, which blocked the blood flow to her feet, and she was ultimately returned to surgery, where the autonomic nerves to the vessels of her extremity were cut in an attempt to increase the arterial flow of blood to her extremities. At this time it was also necessary to partially amputate a portion of her right foot (transmetatarsal amputation). She continued to improve and was discharged after 39 days of hospitalization. Thirteen months later she was again seen because of fullness that had developed over the site of graft. She was given oral cephalexin for one week as an outpatient, but was later hospitalized. The right femoral area was explored surgically, a sample of fluid was collected, and debridement was carried out (removal of affected tissues). Cultures of the fluid showed an infection of the organism Pseudomonas stutzeri. A course of antibiotic therapy with cefoperazone was undertaken, but this conservative treatment failed and additional surgery to replace the aortic graft was required. The woman continued on antibiotics following this surgery and is well one year later. This case is unusual in that P. stutzeri is infrequently isolated in graft infections. The case points out the need for scrupulous sterile technique during surgery, as prevention is best when dealing with vascular grafts. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Blood vessels, Pseudomonas infections, Vascular grafts

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Escherichia coli septic arthritis of a shoulder in a diabetic patient

Article Abstract:

Septic arthritis occurs when a bacterial infection develops in a joint. In most cases, only one joint is affected and the bacteria cause pus to form (suppurative arthritis). However, some bacteria, such as Neisseria gonorrhoeae, cause symptoms in more than one joint. Staphylococcus aureus is the most common cause of suppurative arthritis in adults and of bacterial arthritis in children less than two years of age. Escherichia coli and pseudomonas bacteria are the most common gram negative bacteria that cause bacterial arthritis. Bacterial arthritis caused by pseudomonas is common in drug addicts. E. coli arthritis is rare and usually occurs in the hip, shoulder, or knee. It can be treated with antibiotics such as ampicillin, sulfamethoxazole-trimethoprim, aztreonam, and cephalosporins. Several different factors can increase the risk of developing a joint infection, including diabetes mellitus, sickle cell anemia, drug abuse, rheumatoid arthritis, osteoarthritis, cirrhosis of the liver, and treatment with drugs that suppress the immune system. This article describes the case report of a 63-year-old diabetic man who developed E. coli arthritis in his shoulder. The patient had symptoms of swelling, fever and chills, and constant pain in his right shoulder. Mobility of the shoulder was reduced because of the severity of the pain. A sample of fluid was removed from the joint and was found to contain E. coli. The patient was treated successfully with a combination of ampicillin and chloramphenicol. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Arthritis, Infectious, Infectious arthritis, Escherichia coli infections

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