RESUMEN
A 41-year-old woman was admitted to the hospital with meningitis caused by Listeria monocytogenes. Because of her Crohn's disease she used prednisolone and azathioprine. Two weeks before presenting with meningitis, infliximab had been given as the other immunosuppressant drugs had no effect. This tumour necrosis factor alpha (TNF alpha) blocking agent is known to increase the risk of opportunistic infections. This is the first Dutch patient described with meningitis caused by L. monocytogenes after treatment with infliximab. She recovered after antibiotic therapy. When antibiotic treatment is chosen, the possibility of opportunistic infections in patients who use infliximab concurrently with other immunosuppressant drugs should be taken into account.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Fármacos Gastrointestinales/efectos adversos , Meningitis por Listeria/inducido químicamente , Infecciones Oportunistas/inducido químicamente , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto , Anticuerpos Monoclonales/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Fármacos Gastrointestinales/uso terapéutico , Humanos , Infliximab , Listeria monocytogenes/crecimiento & desarrollo , Meningitis por Listeria/inmunología , Infecciones Oportunistas/inmunología , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
OBJECTIVES: The diagnosis of tuberculous meningitis is easily missed because the variety of symptoms give rise to problems with the differential diagnosis. MATERIAL: Five cases of difficult to diagnose tuberculous meningitis are presented. RESULTS: Several reasons for the diagnostic delay are highlighted. The fact that tuberculous meningitis is rather rare in developed countries contributes to this problem. Recommendations for a quick diagnosis are given. CONCLUSION: The diagnosis of tuberculous meningitis in developed countries is often made after a substantial delay. In case of suspicion on the diagnosis additional examination should be performed and treatment should be started immediately.
Asunto(s)
Tuberculosis Meníngea/diagnóstico , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tuberculosis Meníngea/patologíaRESUMEN
Pachymeningitis luetica is extremely rare in developed countries. We describe a 41-year-old male patient with pachymeningitis luetica, multiple ischaemic infarctions, and severe hydrocephalus. The delay in making the diagnosis contributed to patient's death. Rapid diagnosis is essential on the slightest suspicion of an infection by Treponema pallidum, because timely treatment with antibiotics is effective.
Asunto(s)
Encéfalo/microbiología , Errores Diagnósticos , Hidrocefalia/microbiología , Neurosífilis/diagnóstico , Treponema pallidum/aislamiento & purificación , Adulto , Encéfalo/patología , Encefalopatías/diagnóstico , Diagnóstico Diferencial , Resultado Fatal , Humanos , Hidrocefalia/cirugía , Masculino , Neurosífilis/microbiología , Tabes Dorsal/complicaciones , Tabes Dorsal/diagnóstico , Derivación Ventriculoperitoneal/efectos adversosRESUMEN
Multiple sclerosis (MS) is predominantly a progressive immune-mediated disease of the white matter in the brain. We used single photon emission tomography (SPET) and cobalt-57 (57Co) as a calcium (Ca) analogue to visualize brain tissue damage, based on the fact that Ca influx occurs in both cell death and T-lymphocyte activation in MS. The aim of this study was to determine if 57Co-SPET detects MS lesions and, if so, to compare this with clinical data on the patient. Five MS patients underwent neurological examination including Expanded Disability Status Scale (EDSS) assessment and 57Co-SPET, using a single-headed camera. All available data were compared. The lesions were recognized as areas of increased signal intensity, although the poor count rate did not allow any statistical quantification. A relationship between one 57Co-SPET parameter (cobalt plaque load) and EDSS was demonstrated. In conclusion, this pilot study suggests that 57Co-SPET using a single-headed camera is not an appropriate imaging modality in MS. To obtain a more favourable signal-to-noise ratio, the use of a multi-headed camera, the administration of a higher activity of 57Co and a longer acquisition time are recommended. Validation of this method among a larger group of patients and a comparison with healthy volunteers is needed.