BACKGROUND This case highlights the importance of a multidisciplinary approach in differentiating localized infections from systemic inflammatory diseases like psoriatic arthritis.Nail psoriasis can mimic conditions l...BACKGROUND This case highlights the importance of a multidisciplinary approach in differentiating localized infections from systemic inflammatory diseases like psoriatic arthritis.Nail psoriasis can mimic conditions like paronychia,complicating diagnosis.We wrote this report to emphasize the need for clinical vigilance when interpreting imaging findings,especially in patients with a family history of psoriasis.Misdiagnosis can lead to unnecessary systemic treatments,underscoring the significance of dermatological input in achieving accurate diagnoses.CASE SUMMARY A 56-year-old woman presented with redness and swelling of multiple fingertips.Her family history of psoriasis raised suspicion of psoriatic arthritis.Two rheumatologists diagnosed psoriatic arthritis based on ultrasound findings of enthesitis with a positive Doppler signal and recommended methotrexate.However,she was reluctant to initiate therapy due to potential side effects.At our Rheumatology Center,paronychia was suspected,and laboratory tests excluded systemic inflammatory arthritis.Dermatological examination confirmed paronychia,and treatment with fluconazole and ceftriaxone was initiated to address suspected mixed bacterial and fungal infections.Imaging studies,including hand and wrist X-rays,showed no erosions or other signs of psoriatic arthritis.The patient responded well to antimicrobial therapy,with resolution of symptoms.This case highlights the need for thorough clinical evaluation,careful interpretation of imaging findings,and collaboration between rheumatologists and dermatologists to avoid misdiagnosis and inappropriate treatment.CONCLUSION This case underscores the need for thorough clinical evaluation and caution in interpreting nonspecific imaging findings,especially in patients with a family history of psoriasis.While familial predisposition may raise suspicion for psoriatic arthritis,it is essential to integrate laboratory data,imaging studies,and clinical presentation,including response to targeted antimicrobial therapy.A multidisciplinary approach,involving both rheumatologists and dermatologists,is crucial to preventing misdiagnosis,ensuring appropriate treatment,and avoiding the potential harms of unwarranted therapies.展开更多
BACKGROUND Cervical spine pyogenic infection(CSPI)is a rare and challenging form of spinal infection that is typically caused by pyogenic bacteria and primarily affects the cervical vertebral bodies and surrounding ti...BACKGROUND Cervical spine pyogenic infection(CSPI)is a rare and challenging form of spinal infection that is typically caused by pyogenic bacteria and primarily affects the cervical vertebral bodies and surrounding tissues.Given its nonspecific symptoms,such as fever and neck pain,early diagnosis is crucial to prevent severe complications,including spinal cord injury.We report a previously unreported case of acute CSPI arising from chronic paronychia,exploring its diagnostic and therapeutic challenges through a review of the current literature.CASE SUMMARY The presented case involved a 15-year-old man with CSPI caused by Staphylococcus aureus,which led to complications including bacteremia and a paronychiaassociated abscess.Acute pyogenic infection was initially diagnosed by typical symptoms and blood culture.Fever improved after antibiotic treatment while developing progressive limbs dysfunction.Six days after admission,the patient underwent anterior cervical debridement+autogenous iliac bone graft fusion+plate internal fixation and received 12 weeks of antibiotic treatment after the operation.Re-examination 3 years postoperatively showed that the patient had stable cervical fixation,no significant neck pain or upper limb abnormalities,and normal urinary function.CONCLUSION Early imaging findings,laboratory markers,and timely antibiotic treatment are crucial for CSPI management,preventing complications and facilitating recovery.展开更多
Background: Chronic paronychia is a chronic inflammatory reaction of the proximal and lateral nail folds of multifactorial in etiology like irritant, bacterial and monilial causes. But housewife work is a major cause ...Background: Chronic paronychia is a chronic inflammatory reaction of the proximal and lateral nail folds of multifactorial in etiology like irritant, bacterial and monilial causes. But housewife work is a major cause of chronic paronychia. Objective: To assess the efficacy and prophylactic effects of Vaseline by occlusion of nail folds in comparison with nystatin ointment and fucidic acid in treatment of housewife chronic paronychia. Patients and Methods: This double, blinded, comparative therapeutic, clinical trial is conducted at the Department of Dermatology-Baghdad Teaching Hospital from May 2010 to May 2011. Eighty female housewife patients with chronic paronychia were included in this trial. They were divided into three groups according to the following therapeutic model: Group A treated by Vaseline consisted of 40 patients;Group B and Group C treated by nystatin ointment, fucidic acid ointment respectively and each group consisted of 20 patients. All demographic points related to the disease were recorded from all patients. Invented score system was applied to assess the severity of disease and the response to therapy. Patients had used therapy twice daily on the proximal and lateral nail folds. Treatment duration was 12 weeks. Results: Group A (Vaseline): The recovery rate after 12 weeks of treatment was 26 (65%) patients, while there was no recovery in 14 (35%) patients. Group B (Nystatin ointment): The recovery rate after 12 weeks was 13 (65%) cases and there was no recovery in 7 (35%) patients. Group C (Fucidic acid ointment): The recovery rate 12 weeks of treatment was 12 (60%) patients and there was no recovery in 8 (40%) patients. The earliest signs of recovery in all groups were decreased in nail fold tenderness, redness, swelling followed by improvement in the nail shape, then decreased in the separation of proximal nail fold from nail bed followed by re-growth of cuticle. There was significant difference in clinical response before and after therapy in all groups (P ≤ 0.0001) while there was no statistical significant difference when the three groups were compared with each other (P = 0.784). Conclusions: Vaseline occlusion therapy of the nail folds in patient with chronic paronychia was enough to induce recovery from the disease and there was no statistical significant difference when compared with nystatin or fucidic acid treatment of chronic paronychia.展开更多
文摘BACKGROUND This case highlights the importance of a multidisciplinary approach in differentiating localized infections from systemic inflammatory diseases like psoriatic arthritis.Nail psoriasis can mimic conditions like paronychia,complicating diagnosis.We wrote this report to emphasize the need for clinical vigilance when interpreting imaging findings,especially in patients with a family history of psoriasis.Misdiagnosis can lead to unnecessary systemic treatments,underscoring the significance of dermatological input in achieving accurate diagnoses.CASE SUMMARY A 56-year-old woman presented with redness and swelling of multiple fingertips.Her family history of psoriasis raised suspicion of psoriatic arthritis.Two rheumatologists diagnosed psoriatic arthritis based on ultrasound findings of enthesitis with a positive Doppler signal and recommended methotrexate.However,she was reluctant to initiate therapy due to potential side effects.At our Rheumatology Center,paronychia was suspected,and laboratory tests excluded systemic inflammatory arthritis.Dermatological examination confirmed paronychia,and treatment with fluconazole and ceftriaxone was initiated to address suspected mixed bacterial and fungal infections.Imaging studies,including hand and wrist X-rays,showed no erosions or other signs of psoriatic arthritis.The patient responded well to antimicrobial therapy,with resolution of symptoms.This case highlights the need for thorough clinical evaluation,careful interpretation of imaging findings,and collaboration between rheumatologists and dermatologists to avoid misdiagnosis and inappropriate treatment.CONCLUSION This case underscores the need for thorough clinical evaluation and caution in interpreting nonspecific imaging findings,especially in patients with a family history of psoriasis.While familial predisposition may raise suspicion for psoriatic arthritis,it is essential to integrate laboratory data,imaging studies,and clinical presentation,including response to targeted antimicrobial therapy.A multidisciplinary approach,involving both rheumatologists and dermatologists,is crucial to preventing misdiagnosis,ensuring appropriate treatment,and avoiding the potential harms of unwarranted therapies.
基金Supported by the Guangxi University of Chinese Medicine Doctoral Startup Research Fund Project,No.2018BS065Department of Traditional Chinese Orthopedics,Guangxi International Zhuang Medicine Hospital,No.[2021]33.
文摘BACKGROUND Cervical spine pyogenic infection(CSPI)is a rare and challenging form of spinal infection that is typically caused by pyogenic bacteria and primarily affects the cervical vertebral bodies and surrounding tissues.Given its nonspecific symptoms,such as fever and neck pain,early diagnosis is crucial to prevent severe complications,including spinal cord injury.We report a previously unreported case of acute CSPI arising from chronic paronychia,exploring its diagnostic and therapeutic challenges through a review of the current literature.CASE SUMMARY The presented case involved a 15-year-old man with CSPI caused by Staphylococcus aureus,which led to complications including bacteremia and a paronychiaassociated abscess.Acute pyogenic infection was initially diagnosed by typical symptoms and blood culture.Fever improved after antibiotic treatment while developing progressive limbs dysfunction.Six days after admission,the patient underwent anterior cervical debridement+autogenous iliac bone graft fusion+plate internal fixation and received 12 weeks of antibiotic treatment after the operation.Re-examination 3 years postoperatively showed that the patient had stable cervical fixation,no significant neck pain or upper limb abnormalities,and normal urinary function.CONCLUSION Early imaging findings,laboratory markers,and timely antibiotic treatment are crucial for CSPI management,preventing complications and facilitating recovery.
文摘Background: Chronic paronychia is a chronic inflammatory reaction of the proximal and lateral nail folds of multifactorial in etiology like irritant, bacterial and monilial causes. But housewife work is a major cause of chronic paronychia. Objective: To assess the efficacy and prophylactic effects of Vaseline by occlusion of nail folds in comparison with nystatin ointment and fucidic acid in treatment of housewife chronic paronychia. Patients and Methods: This double, blinded, comparative therapeutic, clinical trial is conducted at the Department of Dermatology-Baghdad Teaching Hospital from May 2010 to May 2011. Eighty female housewife patients with chronic paronychia were included in this trial. They were divided into three groups according to the following therapeutic model: Group A treated by Vaseline consisted of 40 patients;Group B and Group C treated by nystatin ointment, fucidic acid ointment respectively and each group consisted of 20 patients. All demographic points related to the disease were recorded from all patients. Invented score system was applied to assess the severity of disease and the response to therapy. Patients had used therapy twice daily on the proximal and lateral nail folds. Treatment duration was 12 weeks. Results: Group A (Vaseline): The recovery rate after 12 weeks of treatment was 26 (65%) patients, while there was no recovery in 14 (35%) patients. Group B (Nystatin ointment): The recovery rate after 12 weeks was 13 (65%) cases and there was no recovery in 7 (35%) patients. Group C (Fucidic acid ointment): The recovery rate 12 weeks of treatment was 12 (60%) patients and there was no recovery in 8 (40%) patients. The earliest signs of recovery in all groups were decreased in nail fold tenderness, redness, swelling followed by improvement in the nail shape, then decreased in the separation of proximal nail fold from nail bed followed by re-growth of cuticle. There was significant difference in clinical response before and after therapy in all groups (P ≤ 0.0001) while there was no statistical significant difference when the three groups were compared with each other (P = 0.784). Conclusions: Vaseline occlusion therapy of the nail folds in patient with chronic paronychia was enough to induce recovery from the disease and there was no statistical significant difference when compared with nystatin or fucidic acid treatment of chronic paronychia.
