Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Septic arthritis induced by Streptococcus pneumoniae is an uncommon manifestation of pneumococcal infection. Pneumococcus has been identified as the inciting pathogen in only 6% of cases of septic arthritis in recent retrospective studies (Ross et al., 2003). Approximately 50% of patients with pneumococcal septic arthritis have a preceding or concurrent extra-articular focus of infection. The septic joint evolves from hematogenous seeding of the highly vascular synovial membrane by bacteria. Polyarticular disease occurs in only approximately 36% of patients. Most pneumococcal septic arthritis occurs with coexistant joint disease, prosthesis, alcoholism, HIV infection, or rheumatoid arthritis (Baraboutis & Skoutelis, 2004; Raad & Peacock, 2004). We report a case of polyarticular septic arthritis as the first manifestation of an underlying disease. Our literature review discloses that this is the first reported case of multiple myeloma initially presenting as pneumococcal septic arthritis in the USA and the third internationally (Cuesta et al., 1992; Renou et al., 2007).
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PMID:Pneumococcal septic arthritis as the initial presentation of multiple myeloma. 1819 Apr 74

Increased susceptibility to bacterial infections is a common manifestation of multiple myeloma (MM), arising mainly from a defect in humoral immunity and is associated with major morbidity and mortality. The propensity to infection is increased in the first months after the initial diagnosis and in patients with renal dysfunction. Gram-positive infections, mainly pneumonia from Streptococcus pneumoniae, occur more frequently in patients with untreated disease while Gram-negative infections, mainly of the urinary tract, are more common after chemotherapy. However, an acute bacterial infection is rarely reported as the first manifestation of underlying MM. In this review, we analysed data from 17 such cases reported between 1978 and 2008. Median age was 65.5 years and most patients were females; monoclonal paraprotein was IgG in 92%. In contrast to diagnosed treated or untreated MM, musculoskeletal infections predominated in these early cases (47%) followed by pneumonia (29%). In particular, septic arthritis, mainly of the knee, was the most common infectious complication (35%). Streptococcus pneumoniae was isolated in two-thirds of infections and bacteremia was common (80%). In this early phase, immunodeficiency arised from a decreased synthesis of polyclonal immunoglobulins. White blood cell counts were frequently normal, particularly in musculoskeletal infections. Renal impairment occurred in 67% and correlated with increasing monoclonal paraprotein levels. The outcome was favorable in most cases (79%). MM should be considered in previously asymptomatic middle-aged patients who present with a major acute bacterial infection, without an apparent predisposing factor. In particular, suspicion should be high in cases of septic arthritis and pneumococcaemia.
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PMID:Multiple myeloma presenting with an acute bacterial infection. 1948 65

The authors present the case of a 43-year-old male who presented at the emergency department, with a mean arterial pressure of 48 mm of Hg, a sinus tachycardia of 142/min and shallow breathing at 30/min. Two days previously, he started a high-grade fever with a concomitant reddish and painful left knee and right elbow, without any treatment. Septic shock was diagnosed and the patient was started on empiric antibiotics combining ceftriaxone and vancomycin and vasopressors (norepinephrine). The painful knee and elbow joints were aspirated and cultures grew Streptococcus pneumoniae. The patient's clinical condition improved progressively and after investigation, the diagnosis of multiple myeloma was concluded. Pneumococcal septic arthritis, an extraordinary cause of septic arthritis, is a manifestation of an underlying disease and can be responsible for septic shock. Its diagnosis should direct further investigations. It can occur in patients with joint disease but should emphasise the search of systemic immunosuppression.
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PMID:Streptococcus pneumoniae causing septic arthritis with shock and revealing multiple myeloma. 2269 89

Surface defects have a central position in diagnosis of articular pathology. Recognizing the limitations of standard radiologic techniques and those imposed by positioning and averaging artifacts on CT evaluation, direct visualization of surface defects was pursued to identify disease characteristics that would facilitate interpretation of radiologic findings. Epi-illumination surface microscopy was utilized to examine macroscopically recognized articular surface defects in individuals in the Hamann-Todd, Terry, and Huntington human skeletal collections with previously verified diagnoses of rheumatoid arthritis, spondyloarthropathy, juvenile inflammatory arthritis (JIA), calcium pyrophosphate deposition disease (CPPD), gout, metastatic cancer, multiple myeloma, septic arthritis, tuberculosis, fungal arthritis, histiocytosis and sickle cell anemia (Rothschild and Rothschild Clin Infect Dis 20(5):1402-1408, 1995; Rothschild et al. Amer J Phys Anthropol 82(4):441-449, 1990; Rothschild and Rothschild Amer J Phys Anthropol 96(4):357-563, 1995; Rothschild and Woods Clin Exp Rheumatol 10(2):117-122, 1992; Barrett and Keat Radiographics 24(6):1679-1691, 2004; Rothschild and Heathcote Amer J Phys Anthropol 98(4):519-525, 1995; Rothschild and Woods Am J Phys Anthropol 85:25-34, 1991; Hershkovitz et al. Amer J Phys Anthropol 106(1):47-60, 1998; Winland et al. Amer J Phys Anthropol 24:S243, 1997; Rothschild et al. Clin Exp Rheumatol 10(6):557-564, 1992; Rothschild and Martin , 2006; Rothschild et al. Amer J Phys Anthropol 102(2):249-264, 1997). Observed alterations were compared with standard radiographs. Fronts of resorption distinguished inflammatory arthritis from those caused by the other disorders studied. Multiple myeloma, fungal disease, and gout are expansile character; the latter accompanied by reactive new bone formation more prominent than that noted with spondyloarthropathy and JIA. Those were clearly distinguished from the crumbling alterations found with CPPD. Histiocytosis had a unique crenulated appearance, while nodules were prominent with syphilis. Defects in sickle cell anemia had ivory fragments at their base. These findings provided explanation for radiologic observations. Direct surface microscopy revealed characteristics apparently pathognomonic for specific disorders and facilitated distinguishing among them. The technique provides visualization an order of magnitude greater than that available with clinical radiologic techniques and identifies new characteristics which should facilitate clinical diagnoses. This demonstrates that there would be value to the development of higher resolution, clinically applicable imaging techniques.
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PMID:Differential diagnostic perspectives provided by en face microscopic examination of articular surface defects. 2939 6


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