We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated a... more We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated as a tubercular spondylodiscitis with antituberculous therapy drugs. One month later, the patient developed difficulty in walking with motor weakness in both lower limbs and a second magnetic resonance imaging scan revealed an increase in the volume of pus with cord compression. Pedicle screw stabilization (T9–L4) with T12-L1 laminectomy and curettage of the disc space was performed. Achromobacter denitrificans was identified in aerobic culture. He was treated with an extended course of antibiotics, and subsequently, the lower limb motor power recovered, and biochemical parameters returned to normal. To the best of our knowledge, there has been no report of Achromobacter causing spondylodiscitis in English medical literature. This report focuses on the steps taken in management with special reference to antibiotic therapy.
Brown tumors are nonneoplastic bony lesions resulting from primary, secondary or tertiary hyperpa... more Brown tumors are nonneoplastic bony lesions resulting from primary, secondary or tertiary hyperparathyroidism. Primary hyperparathyroidism is caused by parathyroid adenomas or parathyroid hyperplasia while chronic renal failure is a common cause of secondary hyperparathyroidism. Elevated parathyroid hormone levels cause increased osteoclastic activity, bone resorption and reactive fibroblastic proliferation leading to the formation of Brown tumor. Although Brown tumors are more commonly seen in the maxilla and mandible, it can occur in the long, flat bones or any bone. It is less commonly seen in the spine. In this report, we discuss the presentation, management, difficulties with histopathological diagnosis, and follow-up of a Brown tumor in a 55-year-old gentleman undergoing renal dialysis who presented with thoracic compressive myelopathy. Our patient underwent a T4 laminectomy, tumor debulking, and T2–T6 instrumented posterior fusion. Based on histopathological examination of the tissue specimen and raised serum parathyroid hormone levels, we arrived at a diagnosis of Brown tumor. Our review of the literature revealed 62 cases of vertebral Brown tumor resulting in neurologic symptoms. The lesion was more common in females (58%), those aged between 40 and 49 years (26%), and in the thoracic spine (51.6%). Early surgical intervention and management of the underlying cause of hyperparathyroidism lead to sustained symptomatic improvement. Brown tumor should be considered in the differential diagnosis of expansile vertebral lesions in the presence of hyperparathyroidism or chronic kidney disease. Treatment of the underlying hyperparathyroidism and decompression of the neural structures with or without stabilization is recommended.
We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated a... more We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated as a tubercular spondylodiscitis with antituberculous therapy drugs. One month later, the patient developed difficulty in walking with motor weakness in both lower limbs and a second magnetic resonance imaging scan revealed an increase in the volume of pus with cord compression. Pedicle screw stabilization (T9–L4) with T12-L1 laminectomy and curettage of the disc space was performed. Achromobacter denitrificans was identified in aerobic culture. He was treated with an extended course of antibiotics, and subsequently, the lower limb motor power recovered, and biochemical parameters returned to normal. To the best of our knowledge, there has been no report of Achromobacter causing spondylodiscitis in English medical literature. This report focuses on the steps taken in management with special reference to antibiotic therapy.
Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esoph... more Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report- A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum five months prior to presentation. The lady presented with infrascapular chest wall pain of one month’s duration and dyspnoea and wheezing of 15 days duration. Imaging showed a mid-esophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course ...
We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated a... more We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated as a tubercular spondylodiscitis with antituberculous therapy drugs. One month later, the patient developed difficulty in walking with motor weakness in both lower limbs and a second magnetic resonance imaging scan revealed an increase in the volume of pus with cord compression. Pedicle screw stabilization (T9–L4) with T12-L1 laminectomy and curettage of the disc space was performed. Achromobacter denitrificans was identified in aerobic culture. He was treated with an extended course of antibiotics, and subsequently, the lower limb motor power recovered, and biochemical parameters returned to normal. To the best of our knowledge, there has been no report of Achromobacter causing spondylodiscitis in English medical literature. This report focuses on the steps taken in management with special reference to antibiotic therapy.
Brown tumors are nonneoplastic bony lesions resulting from primary, secondary or tertiary hyperpa... more Brown tumors are nonneoplastic bony lesions resulting from primary, secondary or tertiary hyperparathyroidism. Primary hyperparathyroidism is caused by parathyroid adenomas or parathyroid hyperplasia while chronic renal failure is a common cause of secondary hyperparathyroidism. Elevated parathyroid hormone levels cause increased osteoclastic activity, bone resorption and reactive fibroblastic proliferation leading to the formation of Brown tumor. Although Brown tumors are more commonly seen in the maxilla and mandible, it can occur in the long, flat bones or any bone. It is less commonly seen in the spine. In this report, we discuss the presentation, management, difficulties with histopathological diagnosis, and follow-up of a Brown tumor in a 55-year-old gentleman undergoing renal dialysis who presented with thoracic compressive myelopathy. Our patient underwent a T4 laminectomy, tumor debulking, and T2–T6 instrumented posterior fusion. Based on histopathological examination of the tissue specimen and raised serum parathyroid hormone levels, we arrived at a diagnosis of Brown tumor. Our review of the literature revealed 62 cases of vertebral Brown tumor resulting in neurologic symptoms. The lesion was more common in females (58%), those aged between 40 and 49 years (26%), and in the thoracic spine (51.6%). Early surgical intervention and management of the underlying cause of hyperparathyroidism lead to sustained symptomatic improvement. Brown tumor should be considered in the differential diagnosis of expansile vertebral lesions in the presence of hyperparathyroidism or chronic kidney disease. Treatment of the underlying hyperparathyroidism and decompression of the neural structures with or without stabilization is recommended.
We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated a... more We present a case of a 71-year-old male with T12-L1 spondylodiscitis, who was initially treated as a tubercular spondylodiscitis with antituberculous therapy drugs. One month later, the patient developed difficulty in walking with motor weakness in both lower limbs and a second magnetic resonance imaging scan revealed an increase in the volume of pus with cord compression. Pedicle screw stabilization (T9–L4) with T12-L1 laminectomy and curettage of the disc space was performed. Achromobacter denitrificans was identified in aerobic culture. He was treated with an extended course of antibiotics, and subsequently, the lower limb motor power recovered, and biochemical parameters returned to normal. To the best of our knowledge, there has been no report of Achromobacter causing spondylodiscitis in English medical literature. This report focuses on the steps taken in management with special reference to antibiotic therapy.
Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esoph... more Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report- A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum five months prior to presentation. The lady presented with infrascapular chest wall pain of one month’s duration and dyspnoea and wheezing of 15 days duration. Imaging showed a mid-esophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course ...
Uploads
Papers by Thomas Kishen