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"documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2012;8:100-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4660 "formatos" => array:3 [ "EPUB" => 59 "HTML" => 3960 "PDF" => 641 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Compressive Myelopathy as the Presentation Form of a Transdiscal Fracture of the Vertebrae in a Patient With Ankylosing Spondylitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "100" "paginaFinal" => "101" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mielopatía compresiva como forma de presentación de una fractura transdiscal de bloque vertebral en una paciente con espondilitis anquilosante" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1653 "Ancho" => 2500 "Tamanyo" => 291677 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Sagittal images of the thoracolumbar spine in T2 and T1 potentiated sequences, respectively. (C) Sagittal CT scan of the thoracolumbar spine. An alteration in the signal intensity at the D11–D12 level can be seen, corresponding with compressive myelopathy. The CT shows signs of ankylosing spondylitis (fusion of the interapophyseal facets and ossification of the common posterior vertebral ligament) along with signs of degeneration. At the level of D11–D12 the compressive myelopathy's secondary nature can be seen, as the vertebral fracture is evident.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Bueno Palomino, Francisco Bravo Rodríguez, Elisa Roldán Romero, Antonio Cano Sánchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Antonio" "apellidos" => "Bueno Palomino" ] 1 => array:2 [ "nombre" => "Francisco" "apellidos" => "Bravo Rodríguez" ] 2 => array:2 [ "nombre" => "Elisa" "apellidos" => "Roldán Romero" ] 3 => array:2 [ "nombre" => "Antonio" "apellidos" => "Cano Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X11001860" "doi" => "10.1016/j.reuma.2011.05.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X11001860?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574311000529?idApp=UINPBA00004M" "url" => "/21735743/0000000800000002/v1_201305061636/S2173574311000529/v1_201305061636/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574311000244" "issn" => "21735743" "doi" => "10.1016/j.reumae.2011.05.005" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "344" "copyright" => "Elsevier España, S.L." 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Dolores López Prieto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Carmen" "apellidos" => "Carrasco Cubero" "email" => array:1 [ 0 => "maricarmencarrasco@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Priscila" "apellidos" => "Zamora Red" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José Javier" "apellidos" => "Salaberri Maestrojuan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M. Dolores" "apellidos" => "López Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital de Jerez de la Frontera, Servicio Andaluz de Salud, Cádiz, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital de Jerez de la Frontera, Cádiz, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital de Jerez de la Frontera, Cádiz, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artritis séptica por <span class="elsevierStyleItalic">Fusobacterium nucleatum</span> en paciente inmunocompetente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 747 "Ancho" => 900 "Tamanyo" => 71197 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CT of the left knee. There is soft tissue inflammation with an adjacent lytic lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 6-year-old boy was admitted because of pain, swelling and loss of function in his left knee, with an onset 2 weeks prior.</p><p id="par0010" class="elsevierStylePara elsevierViewall">His past medical history included the repeated bouts of otitis, without other diseases.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Two days before, he had presented fever and abdominal pain, which limited itself. The patient had no other musculoskeletal symptoms or oropharyngeal manifestations.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The physical examination showed clear signs of inflammation in his left knee with flexion limitation but full extension. Arthrocentesis was performed, yielding 15<span class="elsevierStyleHsp" style=""></span>cc of synovial fluid of purulent appearance, and samples were sent to the laboratory for culture.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Laboratory tests highlighted a normal leukocyte count, C-reactive protein and elevated erythrocyte sedimentation rate (CRP: 124<span class="elsevierStyleHsp" style=""></span>mg/l and ESR: 30<span class="elsevierStyleHsp" style=""></span>mm/h). Infectious serology was negative (Brucella, Yersinia, Borrelia, Chlamydia, Campylobacter, parvovirus B19), as were blood cultures, Mantoux testing and autoimmunity tests (negative ANA, anti-DNA, ANCA, HLA B27, immunoglobulins and RF). Synovial fluid analysis from the left knee showed signs of inflammation, with 125,200<span class="elsevierStyleHsp" style=""></span>leukocytes/mm<span class="elsevierStyleSup">3</span>, predominance of polymorphonuclear cells (95%), a glucose of 22<span class="elsevierStyleHsp" style=""></span>mg/dl and elevated proteins (5.9<span class="elsevierStyleHsp" style=""></span>g/dl).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The cultures isolated <span class="elsevierStyleItalic">Fusobacterium nucleatum</span>, and there was no antibiotic resistance.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Imaging tests found a diffuse opacity of the right maxillary sinus, with accumulation of secretions inside it and without associated clinical sinusitis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">An ultrasound of the left knee showed moderate synovial effusion and high echogenicity in the posterior recess.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nine days after admission, an MRI was performed which showed a moderate collection in the joint cavity, mainly in the intercondylar notch and showing contrast uptake compatible with synovial proliferation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the back of the left femoral condyle, we identified a small lytic lesion of approximately 7<span class="elsevierStyleHsp" style=""></span>mm×5<span class="elsevierStyleHsp" style=""></span>mm in diameter, associated with a collection that had peripheral contrast uptake, compatible with small bone inflammation. A CT was performed within 20 days, and a 6-mm lytic lesion was seen in the posterior aspect of the medial femoral condyle, with involvement of the cortical bone without any periosteal reaction observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Septic arthritis of the left knee by <span class="elsevierStyleItalic">Fusobacterium nucleatum</span>, with secondary erosion of the left posterior femoral condyle. Right maxillary sinusitis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Progression</span><p id="par0055" class="elsevierStylePara elsevierViewall">On admission, parenteral antibiotic treatment was begun with cephotaxime and cloxacyllin. After receiving the culture positive for <span class="elsevierStyleItalic">Fusobacterium nucleatum</span>, we started treatment with intravenous metronidazole for 21 days. Given the initial evolution showing marked swelling and flexion deformity of the joint, we decided to perform the arthrotomy with debridement and partial synovectomy with surgical drainage and placement of a continuous lavage system, which was maintained for 5 days.</p><p id="par0060" class="elsevierStylePara elsevierViewall">After discharge, oral treatment continued for 2 weeks and the patient underwent rehabilitation. The clinical course was favorable, showing no residual deformity or loss of function.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In later visits, a left knee CT and scintigraphy were performed and were normal, with disappearance of the bone erosion.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Septic arthritis caused by anaerobic microorganisms is rare. It is estimated that its prevalence is below 1%,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and <span class="elsevierStyleItalic">Fusobacterium</span> spp. is the most frequently found germ.</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fusobacterium</span> spp. is a strictly anaerobic bacterium that is part of the flora of the oral, vaginal and intestinal mucosa. There have been reports of septic arthritis by this bacterium after dental procedures, tonsillectomy, dental abscess drainage and other pharyngeal infections.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> In the case of our patient, there was a history of frequent otitis, and signs of right maxillary sinus inflammation as potential risk factors, with normal immunological tests.</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fusobacterium necrophorum</span> is the most virulent germ of the species, classically associated with Lemierre syndrome, which characteristically presents with thrombophlebitis of the internal jugular vein. Only rarely does it cause septic arthritis.</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fusobacterium nucleatum</span> septic arthritis in immunocompetent patients is extremely rare,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with few published cases in children.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a> Hence, the peculiarity of the case is presented.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In septic arthritis it is important to establish a specific treatment early because of the possibility of rapid joint destruction, which would be accompanied by an irreversible loss of functionality. Treatment involves drainage of the joint along with appropriate antibiotic therapy. Drainage can be accomplished through arthrocentesis, arthroscopy, or through open surgical drainage or arthrotomy, as in this case.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Progression" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Carrasco Cubero C, et al. Artritis séptica por <span class="elsevierStyleItalic">Fusobacterium nucleatum</span> en paciente inmunocompetente. Reumatol Clin. 2012;<span class="elsevierStyleBold">8(2)</span>:98–9.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 882 "Ancho" => 900 "Tamanyo" => 89615 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MR of the left knee. The joint space shows occupation of the intercondylar notch and posterior recesses.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 747 "Ancho" => 900 "Tamanyo" => 71197 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CT of the left knee. There is soft tissue inflammation with an adjacent lytic lesion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infectious arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. 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Year/Month | Html | Total | |
---|---|---|---|
2024 October | 22 | 19 | 41 |
2024 September | 79 | 33 | 112 |
2024 August | 85 | 44 | 129 |
2024 July | 55 | 39 | 94 |
2024 June | 88 | 33 | 121 |
2024 May | 58 | 26 | 84 |
2024 April | 68 | 33 | 101 |
2024 March | 57 | 42 | 99 |
2024 February | 57 | 37 | 94 |
2024 January | 39 | 31 | 70 |
2023 December | 62 | 31 | 93 |
2023 November | 77 | 57 | 134 |
2023 October | 62 | 24 | 86 |
2023 September | 117 | 43 | 160 |
2023 August | 95 | 21 | 116 |
2023 July | 86 | 26 | 112 |
2023 June | 82 | 35 | 117 |
2023 May | 63 | 26 | 89 |
2023 April | 60 | 20 | 80 |
2023 March | 74 | 22 | 96 |
2023 February | 44 | 26 | 70 |
2023 January | 49 | 23 | 72 |
2022 December | 59 | 36 | 95 |
2022 November | 88 | 53 | 141 |
2022 October | 79 | 40 | 119 |
2022 September | 113 | 46 | 159 |
2022 August | 79 | 60 | 139 |
2022 July | 65 | 49 | 114 |
2022 June | 72 | 45 | 117 |
2022 May | 81 | 47 | 128 |
2022 April | 96 | 49 | 145 |
2022 March | 69 | 64 | 133 |
2022 February | 51 | 36 | 87 |
2022 January | 43 | 43 | 86 |
2021 December | 42 | 40 | 82 |
2021 November | 76 | 46 | 122 |
2021 October | 62 | 71 | 133 |
2021 September | 49 | 47 | 96 |
2021 August | 19 | 44 | 63 |
2021 July | 78 | 73 | 151 |
2021 June | 50 | 46 | 96 |
2021 May | 72 | 59 | 131 |
2021 April | 178 | 106 | 284 |
2021 March | 81 | 36 | 117 |
2021 February | 66 | 32 | 98 |
2021 January | 49 | 29 | 78 |
2020 December | 27 | 33 | 60 |
2020 November | 45 | 23 | 68 |
2020 October | 24 | 25 | 49 |
2020 September | 47 | 41 | 88 |
2020 August | 36 | 21 | 57 |
2020 July | 26 | 15 | 41 |
2020 June | 48 | 30 | 78 |
2020 May | 42 | 15 | 57 |
2020 April | 35 | 13 | 48 |
2020 March | 31 | 9 | 40 |
2020 January | 4 | 0 | 4 |
2019 September | 4 | 0 | 4 |
2019 June | 1 | 0 | 1 |
2019 March | 1 | 0 | 1 |
2019 January | 1 | 0 | 1 |
2018 May | 7 | 3 | 10 |
2018 April | 64 | 10 | 74 |
2018 March | 62 | 16 | 78 |
2018 February | 29 | 7 | 36 |
2018 January | 35 | 3 | 38 |
2017 December | 41 | 6 | 47 |
2017 November | 52 | 5 | 57 |
2017 October | 39 | 7 | 46 |
2017 September | 48 | 6 | 54 |
2017 August | 59 | 5 | 64 |
2017 July | 58 | 9 | 67 |
2017 June | 74 | 10 | 84 |
2017 May | 67 | 6 | 73 |
2017 April | 47 | 4 | 51 |
2017 March | 42 | 6 | 48 |
2017 February | 48 | 5 | 53 |
2017 January | 48 | 5 | 53 |
2016 December | 89 | 19 | 108 |
2016 November | 76 | 7 | 83 |
2016 October | 106 | 18 | 124 |
2016 September | 96 | 5 | 101 |
2016 August | 72 | 4 | 76 |
2016 July | 46 | 9 | 55 |
2015 December | 2 | 0 | 2 |
2015 August | 3 | 0 | 3 |
2015 July | 36 | 7 | 43 |
2015 June | 53 | 8 | 61 |
2015 May | 66 | 9 | 75 |
2015 April | 56 | 7 | 63 |
2015 March | 63 | 4 | 67 |
2015 February | 76 | 12 | 88 |
2015 January | 76 | 10 | 86 |
2014 December | 65 | 9 | 74 |
2014 November | 51 | 8 | 59 |
2014 October | 56 | 19 | 75 |
2014 September | 43 | 5 | 48 |
2014 August | 58 | 8 | 66 |
2014 July | 86 | 19 | 105 |
2014 June | 89 | 10 | 99 |
2014 May | 104 | 19 | 123 |
2014 April | 101 | 10 | 111 |
2014 March | 95 | 19 | 114 |
2014 February | 75 | 11 | 86 |
2014 January | 69 | 13 | 82 |
2013 December | 56 | 13 | 69 |
2013 November | 49 | 6 | 55 |
2013 October | 58 | 13 | 71 |
2013 September | 60 | 6 | 66 |
2013 August | 46 | 12 | 58 |
2013 July | 49 | 9 | 58 |
2013 June | 51 | 11 | 62 |
2013 May | 48 | 10 | 58 |
2013 April | 64 | 7 | 71 |
2013 March | 29 | 7 | 36 |
2013 February | 41 | 10 | 51 |
2013 January | 33 | 14 | 47 |
2012 December | 47 | 4 | 51 |
2012 November | 39 | 17 | 56 |
2012 October | 22 | 9 | 31 |
2012 September | 13 | 3 | 16 |
2012 July | 3 | 0 | 3 |
2012 June | 10 | 0 | 10 |
2012 May | 12 | 0 | 12 |
2012 April | 6 | 0 | 6 |