Pyogenic vertebral osteomyelitis: diagnosis and management.

Vertebral osteomyelitis represents a diagnostic challenge to the clinician. Two cases of pyogenic vertebral osteomyelitis occurring weeks to months after a urinary tract infection with Escherichia coli are described. The rarity and subtle clinical presentation of this condition, the presence of pre-existing degenerative arthritic changes, and delayed appearance of radiologic signs of progression to destructive osteomyelitis contributed to a significant delay in diagnosis. Increased awareness of vertebral osteomyelitis as a clinical entity combined with information from radionuclide scanning may permit earlier detection of this condition.     

Brain abscess due to Nocardia

Cerebral Nocardiosis is a rare disease, usually occurring in immunocompromised hosts. We report here two cases of brain abscess due to Nocardia species-one due to usual N. asteroides and other by uncommon N. caviae. N. asteroides affected the brain in a post renal transplant patient, whereas N. caviae caused infection of brain in an apparently healthy individual. To the best of our knowledge, all the previous cases of brain abscess due to Nocardia caviae have been reported in compromised hosts. Agar dilution antimicrobial testing showed relatively higher resistant pattern in N. asteroides. In spite of antimicrobial therapy, both the patients succumbed, one within 4 days and other after an initial improvement for four weeks due to drainage of abscess.The technical assistance of Mr. R.K. Sapra and Mr. Pawan Kumar is greatfully acknowledged.     

Cerebellar abscess due to Blastomyces dermatitidis

A case of cerebellar abscess due to Blastomyces dermatitidis is reported and the literature of central nervous system blastomycosis is reviewed. The case is of interest for two reasons: 1. No obvious site of primary blastomycotic infection was found, despite an extensive search. 2. The focal blastomycotic involvement of the CNS was not associated with meningitis. Only two other such cases are explicitly reported in the literature.     

Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis.

OBJECTIVE--To determine the prevalence of vertebral compression fractures due to osteoporosis in patients with ankylosing spondylitis. DESIGN--Prospective study of 111 consecutive patients; patients with vertebral compression fractures were entered into a case-control study. SETTING--Outpatient clinic at the centre for rheumatic diseases, Glasgow. PATIENTS--111 Consecutive patients with ankylosing spondylitis. Patients with compression fractures were matched for age and sex with two controls selected from the rest of the group. Patients with biconcave vertebral fractures were also studied. MAIN OUTCOME MEASURES--Assessments of spinal deformity and mobility and analysis of lateral radiographs of spines for presence of syndesmophytes. RESULTS--Fifteen patients with compression fractures and five with biconcave fractures were studied. Compared with the controls the patients with compression fractures had increased formation of syndesmophytes in the lumbar spine, whereas those with biconcave fractures had increased formation throughout the spine. Patients with compression fractures also had a greater degree of spinal deformity (distance from wall to tragus 24.5 cm v 12.7 cm in controls), less spinal mobility (20 v 45.6 degrees of flexion), and reduced chest expansion (2 cm v 3cm). CONCLUSION--Vertebral compression fractures due to osteoporosis are a common but frequently unrecognised complication of ankylosing spondylitis and may contribute to the pathogenesis of spinal deformity and back pain.