A 57-year-old Japanese man with abdominal distention was referred to gastroenterologists at our hospital, where abdominal computed tomography revealed ascites and swollen lymph nodes. He was admitted for testing and treatment. Suffering from unremitting hyponatremia, hyperkalemia, hypotension, and hypoglycemia, he was transferred to our division for electrolyte correction and further diagnosis. Hormone stimulation testing revealed adrenal insufficiency. Upon electrophysiology, immunoelectrophoresis, and measurement of vascular endothelial growth factor, POEMS syndrome was diagnosed. POEMS syndrome may underlie adrenal insufficiency and should be considered when polyneuropathy, ascites, and swollen lymph nodes occur along with adrenal insufficiency.
Pyogenic vertebral osteomyelitis is difficult to diagnose and treat. The duration of antibiotic therapy, the administration of treatment, and several other factors regarding pyogenic vertebral osteomyelitis remain controversial. The aim of this investigation was to examine its diagnosis and treatment and consider possible solutions. This was a retrospective study of 11 cases of hospitalized patients with pyogenic vertebral osteomyelitis, including their diagnosis, treatment, and other factors. The diagnosis of vertebral osteomyelitis was confirmed with the combination of imaging and biological evidence. The Erythrocyte Sedimentation Rate (ESR) level served as an index to determine the duration of therapy. The duration from symptom onset to diagnosis was 3-63 (median 10) days. Rate of positive blood cultures were obtained in 8 cases (72.7%). The most frequent comorbidity was infective endocarditis in 4 cases (36.6%). Affected vertebrae were lumber spine in 9 cases (81.8%) and multiple level involvement in 8 cases (72.7%). The mean duration of antibiotic therapy was 69.6 ± 17.9 days, with no recurrence. Patients diagnosed with pyogenic vertebral osteomyelitis require careful examination for infective endocarditis. Lumber level and multiple level involvement were more frequent than had previously been reported. Based on our experience, C-reactive Protein (CRP) is more useful than ESR as an index to evaluate the clinical response to therapy and may help determine the duration of treatment. It is important for general physicians to monitor vertebral osteomyelitis properly and provide an appropriate diagnosis and treatment.
We report the case of a 34-year-old man who was initially diagnosed with a tension-type headache after complaining of a headache and nausea. His headache worsened in severity and it was exacerbated on standing in the upright position. The patient was admitted to the hospital on suspicion of spontaneous low cerebrospinal fluid (CSF) pressure headache.Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement, brain sagging, cerebellar tonsillar herniation, brainstem descent and a subdural hematoma. Successful emergency surgery was undertaken.Spontaneous low CSF pressure headache syndrome is characterized by orthostatic headache, and if such a headache worsens, clinicians should consider a subdural hematoma, a life-threatening complication of this unusual disorder.
We report the case of a 63‐year‐old male with diabetes who was diagnosed with staphylococcal bacteremia. Paralysis of the extremities (right upper, left lower) and bladder and bowel dysfunction developed 5 days after treatment initiation. Spinal magnetic resonance imaging revealed a spinal epidural abscess at the L4/5 level. Despite right upper extremity palsy, there was no visible cervical spine abscess. Emergency surgery was undertaken, which resulted in complete neurological recovery. General physicians must be aware that damage to the spinal cord can be caused not only by direct compression of an epidural abscess but also by impaired blood circulation or inflammation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.