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.
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.
A 79-year-old Japanese man who had undergone thoracic aortic replacement 10 years prior presented with a 3-day history of sore throat. He was initially diagnosed with pharyngitis; however, multiple emboli in the vessels of the left side of the body were recognized. He was diagnosed with thoracic aortic graft infection caused by Candida albicans, with multiple embolisms. Anti-fungal therapy was initiated, but surgical removal of the graft was not performed because of the high risk associated with the operation, and he eventually died. Inappropriate use of antibiotics might have led to a severe fungal infection. As such, the inappropriate use of antimicrobial agents should be avoided.
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.
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