Skull base osteomyelitis after maxillectomy: a rare complication

We report a case of skull base osteomyelitis that presented 4–8 weeks after a level 2 maxillectomy for a plexiform ameloblastoma of the right posterior maxilla. This is an extremely rare complication, and we know of no previously reported cases that developed after maxillectomy. We summarise the presentation, differential diagnosis and management.     

表现为皮肤溃疡和骨髓炎的播散性隐球菌病一例研究

目的 报告一例播散性隐球菌病的临床、实验研究和治疗结果。方法和结果 患者女,33岁。1年前上臂、肩、臀及大腿长结节,此间怀孕并早产。产后半个月新发结节泛发全身。3个月前诊断为“血源播散性肺结核”,但抗结核治疗无效。体检发现面部、牙龈、躯干、臀部及四肢共39个结节和溃疡,左胫、腓骨骨质破坏及窦道。脓涂片及病理活检见脓液和坏死组织内有大量真菌孢子,培养酵母样菌落生长,尿素酶及咖啡酸试验阳性。经API酵母菌反应条和血清学鉴定为新生隐球菌血清型A.将菌种接种于大小鼠后发现脑、肺、肝等易受累。临床分离株核糖体内转录间隔2区序列分析法鉴定为新生隐球菌新生变种。停抗结核药,用抗真菌药治疗。强化段用两性霉素B和氟康唑,维持段口服伊曲康唑。局部用两性霉素B.30d后结节消失,200d后溃疡和窦道全部愈合,277d时停抗真菌药,患者痊愈。     

Aspergillus osteomyelitis: review of 12 cases identified by the Prospective Antifungal Therapy Alliance registry

A review of 12 patients with proven Aspergillus osteomyelitis was undertaken between July 2004 and October 2007. Aspergillus fumigatus was most commonly identified (n = 9). Voriconazole was commonly administered (11/12; 91.7%), and 9 (75.0%) underwent surgery. Seven (58.3%) responded to treatment, and 12-week mortality was 25.0% (3/12). Survival was improved with surgical intervention (P = 0.05).     

Soft tissue coverage of bone —a historical perspective and review

Summary Coverage of bony nonunions and osteomyelitis with either cross-leg flaps or muscle flaps dates back to before the turn of the century. Although today many surgeons prefer muscle flaps there are reports of successful treatment with cutaneous cross-leg flaps. Because of its rich blood supply muscle may have a greater ability to tolerate infection and promote revascularization of bone. A history of these techniques and reports of clinical results are presented.     

Chronische Osteomyelitis und Fistelcarcinom

Zusammenfassung Fistelmalignome auf dem Boden einer chronischen Knochenentzündung sind selten (0,38–2,7%). Die Entwicklung eines derartigen Tumors setzt im allgemeinen eine Verlaufszeit von 30 Jahren im Mittel voraus. Betroffen sind vorwiegend Patienten zwischen 50 und 60 Jahren, wobei Männer statistisch häufiger betroffen sind als Frauen. Bei klinischem Verdacht muß eine Probeexcision erfolgen. Bringt diese keinen eindeutigen Befund, ist eine Wiederholung zu fordern. Gleichzeitig muß eine Metastasierung ausgeschlossen werden (Knochenszintigraphie, RöntgenThorax, Lymphknoten-CT). Therapeutisch kommt nur eine Exarticulation bzw. Amputation der betroffenen Extremität in Frage. Eine Ausräumung der regionalen Lymphknoten wird in der Literatur empfohlen. Patienten, die wegen eines Fistelcarcinoms operiert worden sind, müssen im Rahmen der Tumornachsorge regelmäßig kontrolliert werden.

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Chronic osteomyelitis and malignancy of the fistula

Summary Malignant change following chronic osteomyelitis with draining sinuses is rare (0.38–2.7%). The time from onset of osteomyelitis until malignant changes differs but needs 30 years in an average. Most patients are men between 50 and 60 years of age. If there is any doubt about malignancy (bleeding, tumor growth) biopsy should be performed and repeated if histological findings give no clear diagnosis. Metastases should be excluded by x-ray of the chest, scintigram and CT of the regional lymphnodes. Correct surgical therapy can only be done by amputation or exarticulation of the extremity. Patients who were operated upon malignant carcinoma of a sinus after osteomyelitis ought to be controlled in a regular follow-up including blood test (tumor marker).

     

Unilateral proptosis secondary to diffuse condensing osteomyelitis

Osteomyelitis of the skull is an uncommon disease in the present days, mainly due to the advent of modern and more effective antibiotics. Hematogenous osteomyelitis is very rare. Osteomyelitis of the skull is usually not associated with sclerosis which is commonly seen in the rest of the skeleton. There are only few occasional case reports of condensing osteomyelitis wherein there was sclerosis of the bone associated with osteomyelitis of the skull and epidural abscess. An unusual case of diffuse condensing osteomyelitis of the skull producing unilateral proptosis is reported. The clinical, radiological features and microbiological aspects are presented. The proptosis was treated by excision of the bone behind the eyeball and thus relieving the proptosis and the impaired vision. The patient was given broad spectrum antibiotics for a period of two months. Further management problems are discussed.     

Periostitis and osteomyelitis in chronic drug addicts

Periostitis and osteomyelitis can occur in drug addicts not only by hematogenous dissemination of the infecting organisms, but as a result of introduction of bacteria by direct injection into periosteum or injection through infected skin and subcutaneous tissues. A spectrum of examples of osteomyelitis of the bones of the forearm in drug addicts is presented to illustrate this phenomenon. Neglect of these infections and the trauma of continued injections can lead to extensive tissue and bone loss.     

Septic separation of the symphysis pubis

Summary Symphysial osteomyelitis has been distinguished from osteitis pubis because of the more serious nature of the disease. We report a case in which there was a pelvic separation similar to that seen after trauma or pregnancy. The previously undescribed complications of bladder perforation and pelvic instability are also noted. There was no predisposing cause in this case, in contrast to the 40 previously reported. The causative organism was staphylococcus aureus, but pseudomonas aeruginosa and escherichia coli have also been found in other cases.

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Résume L'ostéomyélite de la symphyse pubienne a pu être distinguée de l'ostéite pubienne en raison de sa plus grande gravité. Nous en rapportons un cas dans lequel existait une disjonction symphysaire semblable à celles que l'on observe après traumatisme ou grossesse. On a également noté des complications jamais décrites, à savoir une perforation vésicale et une instabilité pelvienne. Il n'y avait pas de cause prédisposante dans ce cas, contrairement aux 40 observations précédemment rapportées dans la littérature. La bactérie causale était un staphylocoque doré, mais le pyocyanique et le colibacille ont également été retrouvés dans d'autres cas.

     

A Case of Pelvic Osteomyelitis

A patient presenting with osteomyelitis of the pelvis is described. In this case it was difficult to establish a correct diagnosis by use of scintigraphic scanning, in spite of clear roentgenographic evidence of osteomyelitis.