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Total hip arthroplasty infection due to Mycobacterium bovis, after BCG therapy
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Musculoskeletal system / Annals of Physical and Rehabilitation Medicine 59S (2016) e109–e116
motion among patients with FMS. Analytic clinical tests (OLB and LRT) show reduced ability compared to age based norms. For OLB with open eyes, Ekdahl et al. (1989) considered, 60 s as standard perform. For LRT, Brauer et al. (1999) indicated standard perform is 20 ± 2 cm. We noted similar results for the functional tests such as the BBS and TUG. The patients with FMS demonstrated balance impairments. Balance and gait analysis could be proposed as an objective measurement and treatment to assess the impact of rehabilitation in FM. Further studies are needed in order to take into account the effect of FM heterogeneity. Keywords Fibromyalgia; Gait; Posture; Assessment Disclosure of interest The authors declare that they have no competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.249
Peri-prosthetic infection due to Mycobacterium bovis is a very rare complication of BCG therapy but clinicians should be able to evocate this diagnosis. Keywords Mycobacterium bovis; Prosthetic joint infection; Intravesical BCG therapy; Pseudo-tumoral lesion Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.250 PO077
Multifocal osteonecrosis revealing an antiphospholipid syndrome: Case report Sophie Legrève UCL, médecine physique, Overijse, Belgium
Posters PO076
Total hip arthroplasty infection due to Mycobacterium bovis, after BCG therapy Alban Fouasson-Chailloux 1,∗ , Benoit Metayer 2 , Pierre Menu 1 , Lydie Khatchatourian 3 , Joelle Glemarec 2 , Marc Dauty 1 1 CHU de Nantes, MPR locomotrice et respiratoire, Nantes, France 2 CHU de Nantes, rhumatologie, Nantes, France 3 CHU de Nantes, maladies infectieuses, Nantes, France ∗ Corresponding author. E-mail address: [email protected] (A. Fouasson-Chailloux) Objective The loosening of total joint replacement is a frequent complication after total hip arthroplasty (THA). Septic osteolysis should always be feared. We report here a rare case of hip arthroplasty infection due to Mycobacterium bovis after Bacillus Calmette-Guerin (BCG) therapy in a context of bladder cancer. Observations A 70-year-old man was referred to the department of rheumatology in September 2015, because of a total functional disability of the left lower limb. He underwent an un-cemented left total hip arthroplasty in 2003 for the treatment of osteoarthritis. We noted a bladder carcinoma treated by BCG instillation in 2013. Concerning his lower-limb, the activity-related pain has progressively intensified. No fever, weight loss, night sweat or other constitutional symptoms had been noticed. The medical examination showed an isolated painless mass in the inguinal fold. Initial x-ray showed a large trochanteric bone defect and a medial femoral cortex osteolysis. A CT-scan revealed a mass located between the acetabulum and the femoral vasculo-nervous package. A puncture of the mass yielded a hematic and purulent material. On day 14 of incubation, a BCG Mycobacterium bovis strain developed on a specific mycobacterial culture. Discussion–conclusion Tuberculosis vaccine is an effective intravesical immunotherapy for superficial urothelial bladder carcinoma. Most patients experience irritative voiding. Flu-like symptoms may occur and are resolved with symptomatic treatment. Osteoarticular complications are rare. Only 8 cases of prosthetic infections due to Mycobacterium bovis are reported. There is no predictive factor that could help identify patients at risk for developing BCG infection. Most of patients present sub-acute or chronic joint pain, with a great difficulty and a long delay for clinicians to make the diagnosis. In our case, the pseudo-tumoral aspect associated with the loosening of the THA showed many similarities with polyethylene wear induced osteolysis with a classic inflammatory granuloma. A regimen of antituberculous drugs was essential alongside with the removal of the mass.
Objective Multifocal osteonecrosis is rare. A zone of epiphyseal bone-marrow necrosis of three or more joints characterizes it. The most common risk factors are glucocorticoids intake and alcoholism. However, there is a series of other causes that could be incriminated in osteonecrosis, among which antiphospholipid syndrome. This case report, illustrates a primary antiphospholipid syndrome with only one clinical manifestation: multifocal osteonecrosis. Observations A 30-year-old woman, with a medical history of left total hip replacement (THR), presents with severe right coxalgia and pain in both knees and shoulders. Clinical examination shows right hip severe mobility restriction. A hip radiography and a bone scan ordered to complete the diagnostic, revealed a severe multifocal osteonecrosis of the right hip, the two femoral condyles (at fracture stage) and the two shoulders. Dosage of the antiphospolipids antibodies showed an increase presence of anticardiolipin antibodies in two blood tests performed at a 12-week interval, thus confirming a primary antiphospholipid syndrome diagnosis. Discussion–conclusion Antiphospholipid syndrome must be mentioned as a possible cause in a small number of patients presenting with osteonecrosis, without presence of any major risk factors (as glucocorticoid intake or alcoholism), even without any history of blood clots or miscarriages. Some data suggest that the introduction of an anticoagulant treatment at early stages of osteonecrosis of the femoral head would delay the progression of bone collapse and would prevent the appearance of new bone lesions. Keywords Osteonecrosis; Multifocal; Primary antiphospholipid syndrome Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.251 PO078
Conversion paralyses and physical medicine and rehabilitation: Four cases report
Chafia Allam ∗ , Ouiza Toumi , Nawel Benhassine , Wahiba Chenaf , Nedjma Bouyaghoub , Meriem Bachiri , Ahmed Ahras EHS Ben Aknoun, médecine physique et réadaptation, Alger, Algeria ∗ Corresponding author. E-mail address: chafi[email protected] (C. Allam) Objective Patients with conversion paralyses have the same disabilities and handicaps as patients with organic paralyses. We report 4 cases of patients with conversion paralyses who have been managed in our physical medicine and rehabilitation department during twelve months. Observations Two women and 2 men ages 33, 19, 18 and 41 years presented conversion paralyses. The paralyses were varied: hemi-
Musculoskeletal system / Annals of Physical and Rehabilitation Medicine 59S (2016) e109–e116
motion among patients with FMS. Analytic clinical tests (OLB and LRT) show reduced ability compared to age based norms. For OLB with open eyes, Ekdahl et al. (1989) considered, 60 s as standard perform. For LRT, Brauer et al. (1999) indicated standard perform is 20 ± 2 cm. We noted similar results for the functional tests such as the BBS and TUG. The patients with FMS demonstrated balance impairments. Balance and gait analysis could be proposed as an objective measurement and treatment to assess the impact of rehabilitation in FM. Further studies are needed in order to take into account the effect of FM heterogeneity. Keywords Fibromyalgia; Gait; Posture; Assessment Disclosure of interest The authors declare that they have no competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.249
Peri-prosthetic infection due to Mycobacterium bovis is a very rare complication of BCG therapy but clinicians should be able to evocate this diagnosis. Keywords Mycobacterium bovis; Prosthetic joint infection; Intravesical BCG therapy; Pseudo-tumoral lesion Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.250 PO077
Multifocal osteonecrosis revealing an antiphospholipid syndrome: Case report Sophie Legrève UCL, médecine physique, Overijse, Belgium
Posters PO076
Total hip arthroplasty infection due to Mycobacterium bovis, after BCG therapy Alban Fouasson-Chailloux 1,∗ , Benoit Metayer 2 , Pierre Menu 1 , Lydie Khatchatourian 3 , Joelle Glemarec 2 , Marc Dauty 1 1 CHU de Nantes, MPR locomotrice et respiratoire, Nantes, France 2 CHU de Nantes, rhumatologie, Nantes, France 3 CHU de Nantes, maladies infectieuses, Nantes, France ∗ Corresponding author. E-mail address: [email protected] (A. Fouasson-Chailloux) Objective The loosening of total joint replacement is a frequent complication after total hip arthroplasty (THA). Septic osteolysis should always be feared. We report here a rare case of hip arthroplasty infection due to Mycobacterium bovis after Bacillus Calmette-Guerin (BCG) therapy in a context of bladder cancer. Observations A 70-year-old man was referred to the department of rheumatology in September 2015, because of a total functional disability of the left lower limb. He underwent an un-cemented left total hip arthroplasty in 2003 for the treatment of osteoarthritis. We noted a bladder carcinoma treated by BCG instillation in 2013. Concerning his lower-limb, the activity-related pain has progressively intensified. No fever, weight loss, night sweat or other constitutional symptoms had been noticed. The medical examination showed an isolated painless mass in the inguinal fold. Initial x-ray showed a large trochanteric bone defect and a medial femoral cortex osteolysis. A CT-scan revealed a mass located between the acetabulum and the femoral vasculo-nervous package. A puncture of the mass yielded a hematic and purulent material. On day 14 of incubation, a BCG Mycobacterium bovis strain developed on a specific mycobacterial culture. Discussion–conclusion Tuberculosis vaccine is an effective intravesical immunotherapy for superficial urothelial bladder carcinoma. Most patients experience irritative voiding. Flu-like symptoms may occur and are resolved with symptomatic treatment. Osteoarticular complications are rare. Only 8 cases of prosthetic infections due to Mycobacterium bovis are reported. There is no predictive factor that could help identify patients at risk for developing BCG infection. Most of patients present sub-acute or chronic joint pain, with a great difficulty and a long delay for clinicians to make the diagnosis. In our case, the pseudo-tumoral aspect associated with the loosening of the THA showed many similarities with polyethylene wear induced osteolysis with a classic inflammatory granuloma. A regimen of antituberculous drugs was essential alongside with the removal of the mass.
Objective Multifocal osteonecrosis is rare. A zone of epiphyseal bone-marrow necrosis of three or more joints characterizes it. The most common risk factors are glucocorticoids intake and alcoholism. However, there is a series of other causes that could be incriminated in osteonecrosis, among which antiphospholipid syndrome. This case report, illustrates a primary antiphospholipid syndrome with only one clinical manifestation: multifocal osteonecrosis. Observations A 30-year-old woman, with a medical history of left total hip replacement (THR), presents with severe right coxalgia and pain in both knees and shoulders. Clinical examination shows right hip severe mobility restriction. A hip radiography and a bone scan ordered to complete the diagnostic, revealed a severe multifocal osteonecrosis of the right hip, the two femoral condyles (at fracture stage) and the two shoulders. Dosage of the antiphospolipids antibodies showed an increase presence of anticardiolipin antibodies in two blood tests performed at a 12-week interval, thus confirming a primary antiphospholipid syndrome diagnosis. Discussion–conclusion Antiphospholipid syndrome must be mentioned as a possible cause in a small number of patients presenting with osteonecrosis, without presence of any major risk factors (as glucocorticoid intake or alcoholism), even without any history of blood clots or miscarriages. Some data suggest that the introduction of an anticoagulant treatment at early stages of osteonecrosis of the femoral head would delay the progression of bone collapse and would prevent the appearance of new bone lesions. Keywords Osteonecrosis; Multifocal; Primary antiphospholipid syndrome Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.251 PO078
Conversion paralyses and physical medicine and rehabilitation: Four cases report
Chafia Allam ∗ , Ouiza Toumi , Nawel Benhassine , Wahiba Chenaf , Nedjma Bouyaghoub , Meriem Bachiri , Ahmed Ahras EHS Ben Aknoun, médecine physique et réadaptation, Alger, Algeria ∗ Corresponding author. E-mail address: chafi[email protected] (C. Allam) Objective Patients with conversion paralyses have the same disabilities and handicaps as patients with organic paralyses. We report 4 cases of patients with conversion paralyses who have been managed in our physical medicine and rehabilitation department during twelve months. Observations Two women and 2 men ages 33, 19, 18 and 41 years presented conversion paralyses. The paralyses were varied: hemi-