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Query: UMLS:C0018099 (gout)
 5,192 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Avascular bone necrosis under immunosuppressive therapy is a well known sequel following solid organ transplantation. Most cases affect hip, knees or shoulders in more than one location and occur in connection with the use of high-dose steroids. In this 50 year old female immunosuppressive therapy consisted of sirolimus and mycophenolate mofetil after a renal transplantation 2 years ago. Steroids had been completely withdrawn after avascular necrosis of the femoral head. Physical examination revealed a reddened and painful left ankle. C-reactive protein was elevated while autoimmune antibodies, rheumatoid factor and screening for reactive arthritis remained negative. Joint fluid examination ruled out infection or gout. Plain radiographs were normal. Under the presumptive diagnosis of erysipelas antibiotic therapy was started, however, without success. Magnetic resonance imaging finally revealed bilateral tibial and tarsal bone necrosis as the underlying cause. In conclusion, avascular bone necrosis should remain an important differential diagnosis in patients with bone or joint pain and a history of organ transplantation, regardless of the present use of steroid therapy.
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PMID:[Avascular necrosis of the bone after organ transplantation]. 2033 75

Three types of group A streptococcal infections are particularly feared: necrotizing fasciitis, myositis, and streptococcal toxic shock syndrome (TSS). We present 3 cases of necrotizing fasciitis due to Streptococcus pyogenes, one in an immunocompromised patient who had received kidney transplant and 2 healthy patients. Mean age of patients was 52 years (range, 42-67 years), and all 3 were male. One spontaneous case in absence of any obvious portal of entry is reported. The clinical course was initially indolent but quickly destructive. All patients required emergency surgical debridement and intravenous antibiotics. In 2 cases, intravenous immunoglobulin therapy was added. Differential diagnoses include septic arthritis, cellulitis, gout, other causes of tenosynovitis, erysipelas, and deep vein thrombosis.Blood and soft-tissue cultures should be obtained to identify the bacteria, and emergency computed tomography or magnetic resonance imaging scan should be performed to confirm the diagnosis and define the extension of the necrosis. Aggressive surgical debridement in the first 24 to 48 hours and antibiotic treatment, including penicillin and clindamycin, are the cornerstones in the management of these infections. Adjuvant intravenous immunoglobulin therapy might be useful in case of TSS. Diagnostic and treatment delays are the main causes of mortality in these infections.
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PMID:Necrotizing fasciitis and myositis caused by streptococcal flesh-eating bacteria. 2108 16