P335 Pott's disease: a clinical case

S124

Abstracts

I European

Journal

of Internal

Mycobacterial isolate in liquid medium that reduce growing time in relation to Lowenstein-Jensen (Low) medium. This reduce the time for identification of Mycobacteria and for study drugs resistance. This technique is used in the Department of Clinical Microbiology of our Hospital since two years for diagnosis of Tuberculosis (TB). Aims: 1. To evaluate sensitivity of Ziehl smear and the new system Bactec MGIT 960 on diagnostic of Tuberculosis in our hospital. 2. To establish a temporal correlation between acid-fast bacilli count on Ziehl smear and the growing time of positive cultures in this liquid medium. Patients and methods: A retrospective study of 101 patients diagnosed of TB during 2002 was done in Hospital Clinic0 San Carlos. A protocol was filled counting the acid-fast bacilli on Ziehl smears and registting the growing time on positive cultures in this liquid medium. A Spearman correlation coefficient was established. The data were analysed with the aid of the statistics package SPSS vs. 7.5. Results: They are summarized in table below. MGIT was positive in 96 cases

Ziehl

”

MGIT-** Days/mean & sd

>so

26

5.5 2 I .92

25-50

5

lO.bb~S.03

I O-25

4

7.5~231


J

8.5~2.88

no AFB

51

12.3k5.17

TlXil

96

9.9bi5.24

AFB: acid-fast (p
bacilli.

**Spearman

correlation

coefficient

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was made with insertion of a catheter in the abcess culture of the drenaid material showed a Escherichia

of right coli.

P333 Staphylococcus aureus: a rare cause of acute pyogenic E. Louro, A. Campos, J. Leitao, J. Freire, A. Carvalho, Reis, E. Almiro, A. Port0 (Coimbra, P)

Psoas.

The

infection R. Santos,

C.

Staphylococcus aureus is one of the most human lethal pathogens. Member of Micrococcaceae family, nonmotil, nonsporulate and facultatively gram-positive anaerobic microorganism characterized by individual cocci with a diameter of 0.5 to 1.7 mm is responsible for important infection with high morbidity and mortality in serious ill or immunocompromissed patients and in patients on parenteral therapeutics. The authors analyse 6 cases of S. aureus metastatic abscesses in their departement from January 1983 to February 2003 focusing the physiopathology, diagnosis, treatment and evolution. We conclude that an early diagnosis of acute pyogenic abscess, particularly in immunocompromised patients is mandatory to initiate drainage and prolonged treatment with adequate antibiotics and life support measures.

P334 Cryoglobulinemia in Hepatitis C - a case report H. Gruner, L. Costa, T. Vasconcelos, A. Ferreira, V Madeira

(Lisbon,

I’)

r =0.6521

Conclusions: 1. The sensitiveness of the Zielh smear in the studied sample was 39% and 96% for the MGIT. 2. A high positive correlation exits between the count of acid-fast bacilli on Ziehl smear and the growing time in MGIT positive cultures.

P332 Abcess of Psoas. 2 clinical cases F. Torres, I. Viegas, M. Carvalho (Beju,

Medicine

P)

Abcess of Psoas is an uncommon disease, frequently forgotten, and can result from extention of an adjacent infection:Bone, genitourinary, intestinal (bowel perfuration) or septic hip arthritis. Clinical presentation includes back pain with limitation of function, fever and neutrofilic leuchocitosis. The most frequent etiologic agents are: Mycobacterium Salmonella tuberculosis, Staphylococcus aureus. flora polimicrobiana, enteritidis, Streptococcus intermedius e Escherichia coli. The diagnosis is based in CT Scan or MRI. The therapeutics is based in antibiotic and dreinage of abcess. The authors present 2 clinical cases ocurred in a 3 months period: 1. Patient male. 52 years old, Caucasian with no previous condition, complaining of intense back pain with irradiation to the left leg and impotecy. Initially evaluated by Orthopedics. A CT Scan of spine is done and shows no alterations. Treated with NSAIDs with no amelioration. For persistence of the complains and development of fever and neutrofilic leuchocitosis was admited in our Internal Medicin Service. Further investigations that include a MIR of spine revealed na abcess of right Psoas and a retroperitoneal fluid colection. A needle aspiration was made (guided by CT Scan) with aspiration of 50 cc of pus. The culture of pus:Isolation of Staphylococcus aureus MS. 2. Man, 87 years old, Caucasian, with previous stroke (3 years before), status amputation right leg and cardiac insuficiency. Was admited by descompentation of his cardiac insuficiency, back pain and septic urine. The Ultrasonography showed a large image in the traject of right Psoas. A abdominopelvic CT Scan was done and confirmed the presence of non-pure liquid; drenaige

Hepatitis C (HCV) is associated with extra hepatic manifestations, including several autoimmune syndromes such as mixed cryoglobulinemia, vasculitis and glomerulonephritis (GNA). GNA is secondary to cryoglobulinemia, though direct effect of the virus cannot be excluded. The authors present a case report of a 40-year-old Caucasian male, with ankle, periorbital edema and headache with a 3-month evolution. One week prior to admission he appears with vasculitis of the lower extremities. The patient had Hepatitis C for 8 years and had a history of drug addiction. There was clinical and laboratorial evidence of a nephritic syndrome, characterised by hypertension, edema and proteinuria 3.3 g/24 h. Cryoglobulinemia was 4t. A renal biopsy was made which showed membranoproliferative glomerulonephritis (GNA). The echocardiogram showed hypertensive cardiopathy. Concerning HCV, the genotype was 3a, RNA HCV 553 000 Ul/ml. ALT>2 times the upper limit of normal and the hepatic biopsy showed mild hepatitis. Treatment with plasmapheresis, cyclophosphamide and corticosteroids was initiated. Simultaneously HCV treatment, with pegintron only, as renal insufficiency didn’t allow ribavitin use. There was a laboratorial and clinical improvement and after 3 month, the ALT levels were normal and RNA HCV was not detectable. The simultaneous treatment of cryoglobulinemia and hepatitis C was successful, even without co administration of ribavirin, elevated RNA HCV, elevated ALT, histologically mild hepatitis and elevated cryoglobulinemia.

P335 Pott’s disease: a clinical R. Mendes, F. Malheiro,

case E. Santos,

I. Madruga,

A. Silva

(Lisboa,

P)

Pott’s disease is rare in the Human immunodeficiency virus (HIV) negative population. The authors present the case of a 48-year-old man with past history of Diabetes Mellitus, high blood pressure and alcohol abuse. For the last two years before admission he had described worsening weakness and paresthesias of both lower extremities. There were no other complaints such as cough, fever, night sweats or weight loss. On examination there was a sensory level to pinprick and temperature sensation at T12 and paraparesis. Laboratory testing was normal

Abstracts

I European

Journal

of Internal

except for high sedimentation rate. Serology for HIV was negative. Chest radiograph was unremarkable. Thoracic column Computed tumographic (CT) scan showed lytic and blastic lesions of T12 and a soft tissue compressing mass in the epidural space. A 99Tecnecium bone scan demonstrated ‘hot spots’ in TlO-T12. Thoracic column Magnetic Resonance imaging (MRI) revealed an epidural compressing abscess from Tl I-12, paravertebral mass and irregular erosions in the endplates of adjacent vertebral bodies. The patient was empirically medicated with antituberculous drugs, with great improvement of his complaints starting after two weeks of treatment. A bone biopsy was performed on the 20th day of therapy of with we are still awaiting culture for mycobacterium. A 2nd MRI was performed on the 28th day of therapy and revealed a significant reduction of the lesions described before. In order to avoid further complications of this disease such as paraplegia and kyphosis it is sometimes necessary to initiate empirical treatment, even when there is not yet a positive identification of the microbial agent.

Gastroenterology/Hepatology P336 Hepatic steatosis complicating adult celiac disease: M. CPmara, J.L. Brandao. M. Gonsalves, J. Fraga, Pessegueiro, B. Castro (Santo Antdnio, P)

a case report R. Nogueira,

H.

Nonalcoholic steatohepatitis (NASH) is a clinical entity in witch patient lack a history of significant alcohol consumption, has liver biopsy findings indistinguishable from alcoholic hepatitis. The massive hepatic steatosis complicating adult celiac disease is uncommon occurrence. We report a case of a 26-year-old woman, with history of diarrhea for a long time. Pregnancy in May 2001. In first month pos-part started diarrheas ( > lo/day). Admitted to our ward (March 2002) with jaundice, vomits, hypotension and abdominal distention with pain. Relevant laboratory data included serum: glutamic oxaloacetic transaminase 108 U/L, and serum glutamic-pyruvic transaminase 193 U/L; alkaline phosfatase 156 mg/dl, gamma-glutamyl transpeptidase 155 mg/dl; bilirrubin level was 7.2 mgldl; prothrombine time was 15%, and activated tromboplastin time 47.6 s. Serum markers for hepatitis A, B and C were negatives. Antigliadin and antiendomysium antibodies were positive. Abdominal ultrasonography showed a large liver and ascites. Transjugular liver biopsy: severe steatosis, with hepatocytes contained medium to large fatty vacuoles: hyperplasia of Kupffer cells and fibrosis. Jejunal biopsy: an almost totally flat mucosal relief with crypt hyperplasia, an increased lymphoplasmacytic population in the lamina propria, and many mononuclear cells within the surface epithelium. After 10 days with a gluten-free diet, she had a poor clinical response, maintaining multiples diarrheas, developed an intestinal pseudo occlusion and hepatic encephalopathy. She received an infliximab infusion at a dose of 5 mg/Kg without complications One month later she dramatically improved. Eight months later she was asymptomatic. Repeated duodenal and hepatic biopsy with improvement. This case shows a massive hepatic steatosis complicating adult celiac disease and the beneficial effect of a monoclonal antibody to tumor necrosis factor in treatment of severe celiac disease.

P337 Tropical chronic pancreatitis A. Fernandez, M.F. Guerra, Aguayo (Albacete, E)

in Europe J.P. Arribas,

F. Herreros,

F. Alberta,

J.L.

Background: Malnutrition with protein deficiency, cassava fruit toxicity, impaired immune response, viral infection and genetic susceptibility (mutations in the serine protease inhibitor) have been considered as various factors in the etiology of Tropical Chronic Pancreatitis (TCP), a

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s12.5

condition characterized by recurrent episodes of abdominal pain, protracted malnutrition, ketosis resistant diabetes and dense calcifications in the pancreatic parenchyma. Children are commonly affected and often die in early adulthood from endocrine and exocrine dysfunction. Ten per cent patients with TCP develop pancreatic cancer. Treatment includes control of diabetes, relief of pain with analgesics, pancreatic enzyme replacements, endoscopic or surgical decompression of dilated ducts and removal of pancreatic calculi. Case report: We report a case of TCP in a non-alcoholic 28-year-old woman from the Ecuador Republic, domiciled in Spain since 2001. The patient was admitted to our hospital in December 2002 for para-umbilical pain since 8 days before. The pain was intermittent and dull aching type, sometimes radiating to the back. The first symptoms began when the pt was only 14 y. X-ray (Fig. 1) revealed a radio opaque shadow in the region of pancreas. Ultrasound confirmed the diagnosis of pancreatitis calculi with areas of calcification in the pancreatic area. ERCP (Fig. 2) showed ductal obstruction, and the CT scan and MRI (Fig. 3) showed marked dilatation of the pancreatic duct. The blood examinations showed moderate elevations of serum amylase and alkaline phosphatase, but not sugar elevation. The patient improved with analgesics and pancreatic enzyme replacements, but not surgical decompression had been undertaken yet. Conclusions: Although tropical chronic pancreatitis is seen commonly in the tropics, where is the most common cause of chronic pancreatitis, in the future it will need to be taken into account in the differential diagnosis of chronic pancreatitis in our patients because of the increasing number of immigrants from tropical countries to Europe.

P338 Celiac disease in Turkish population R. Elsurer, G. Tatar, H.Y. Balaban, C. Sokmensuer, TR)

H. Simsek

(Ankara,

Objective: Celiac disease (CD) is characterized by malabsorption of nutrients in small intestine. The availability of highly specific and sensitive serologic tests facilitated the diagnosis, increasing the disease prevalence. CD presentation with severe complications is not uncommon. The aim of this study was to determine the clinical, laboratory and histopathological features of CD in Turkish adults. Material and methods: Between 1968 and 2002, CD patients attending to Gastroenterology Unit were evaluated retrospectively. From 2002, newly diagnosed cases were prospectively followed up. Results: Forty-three patients were included in the study. Of these, 29 (67.4%) were female, 14 (32.6%) were male. The mean body mass index was 22.325.6 kg/m2. The mean age at diagnosis was 37.3212.6 for females and 31.62 12.6 for males. The most common symptoms were diarrhea (69.8%). weight loss (67.4%) and nausea (48.8%). The most common comorbidities (excluding parasite infestations) were anemia (37.2%), osteoporosis (20.9%) and steatohepatitis (9.3%). Of the 43 patients, 6 (14.0%) had a family history of diabetes mellitus, 1 (2.3%) had a family history of CD. The incidence of hepatomegaly and splenomegaly were 4.7% and 7.0% respectively. The plasma glucose levels, serum transaminases, iron parameters, electrolytes, lipid profile and mean hemoglobin values were evaluated. The most common histopathological findings were increased lymphocytes in the lamina propria (74.4%) and increased intraepithelial lymphocytes (IEL) in the villi (58.1%). Over years, the cumulative frequency of CD increased more in females than males. Conclusions; This study shows the characteristics of CD in Turkish adults. In our recent study, the prevalence of tissue transglutaminase antibody positivity in Turkish healthy blood donors was 1.3%, indicating a high prevalence of CD in our population. In this study, the cumulative frequency of CD increased more in females than males. With the better understanding and increased suspicion of the disease, more cases are diagnosed in our population.