Prosthetic joint infection from L. monocytogenes is mainly late. Systemic inflammation may be absent. Although rare, it must be suspected in patients at high risk for both prosthetic joint and listerial infections. In addition, those patients must be instructed on appropriate preventive measures.
Cranial extradural haematoma (EDH) is a neurosurgical emergency that can be caused by traumatic or non-traumatic causes with the former being more prevalent. Nontraumatic causes are variable and can include infection, vascular malformation and haematological disorders. This paper will address an extremely rare non-traumatic cause of EDH. More specifically, eosinophilic granuloma (EG), the localized form of Langerhans histiocytosis, may involve the skull and has rarely been reported to present with EDH. The case that will be presented is that of a three-year-old male patient, who presented with progressive vomiting and drowsiness, associated with left parietal swelling. CT scan of the brain showed an extradural haematoma and an osteolytic parietal lesion. He underwent emergent craniectomy, evacuation of the haematoma and dura resection as the lesion was infiltrating the dura. Histopathological examination of the dura and the bone edges showed eosinophilic granuloma (EG). The mechanism of a haemorrhage in this situation is poorly understood and the literature is extremely scarce. In conducting a thorough literature review, only 11 case reports of EG causing non-traumatic EDH were found. The details of these 11 cases will be reviewed and discussed in this paper, in addition to our illustrative case.
A 78-year-old farmer with a history of diabetes mellitus and rheumatoid arthritis, well controlled with metformin and prednisone 20 mg daily, respectively, presented with erythematous nodular skin lesions over the back of his right thigh of 1-week duration. He had not had any opportunistic infection previously. Two of the lesions were cystic and were aspirated. Fluid culture grew Mycobacterium chelonae. The patient was negative for HIV antibody (Figs. 1-3). M. chelonae is a rapidly growing Mycobacterium (RGM). Unlike other non-tuberculous mycobacteria, RGM produce mature growth on solid mycobacterial media within 7 days. 1 Most commonly, M. chelonae causes skin and soft tissue infections, mainly after a penetrating injury. The infection usually remains localized in immunocompetent patients, but may disseminate in the immunosuppressed. Infection with M. chelonae is best treated with at least two antimicrobial agents, especially in the case of disseminated infection, to avoid the emergence of resistance. Macrolides are considered the drugs of choice. 2 Other potential antibiotics include tetracyclines, fluoroquinolones, aminoglycosides, carbapenems, and oxazolidinones. 3 Treatment is usually continued for 6 months. This patient was treated with clarithromycin and minocycline for 2 months. Clarithromycin was then continued for an additional 4 months. The response to treatment was excellent, with complete resolution of the lesions.
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