BILATERAL ELASTOFIBROMA OF THE SCAPULA: A CASE REPORT AND LITERATURE REVIEW

<p><strong>Introduction:</strong>Elastofibromas are ill-defined, benign lesions typically located on the inferior pole of the scapula underneath the serratus anterior and latissimusdorsi.Elastofibromas are treated surgically to relieve pain and patients can regain range of motion in the shoulder. Bilateral scapulaelastofibromas are extremely rare. To the best of our knowledge, this report details the first case of symptomatic bilateral elastofibromas of the scapula in a patient younger than 60 years of age.</p><p><strong>Case presentation: </strong>A 51-year-old woman with diabetes mellitus and hypertension presented to the orthopedic clinic at King Saud University Medical City in August 2022. The patient had begun experiencing dull bilateral shoulder pain, with swelling which began five years. Patient denied any constitutional symptoms. A physical examination revealed a 7 8cm mass on the right scapula and a 6 7cm mass on the left scapula. There was no tenderness over the mass, and in both shoulders, the range of motion was restricted. MRI of both shoulders revealed increased intensity in the T1 andT2 axial and coronal cuts (Figures 3A-D). The right-side mass was 8 9cm, and the left-side mass was 8 7cm. Excisional biopsy is done for both lesions in separate time and sent for histopathology which confirmed the diagnosis of Elastofibroma. Also, the patient regains her full functionality of both shoulders, and the pain was resolved</p><p><strong>Conclusion: </strong>Elastofibroma can present on both shoulders, lead to chronic shoulder pain and decrease the functionality of the shoulders. Elastofibroma should be diagnosed by MRI and treated surgically by excision to improve the pain and functionality. </p><p> </p&gt

Molecular typing and antimicrobial resistance of group B Streptococcus clinical isolates in Saudi Arabia

ABSTRACT: Objectives: Group B Streptococcus (GBS) has emerged as an important cause of severe infections in adults. However, limited data are available regarding the epidemiology of GBS in Saudi Arabia. Methods: Isolates were collected over a period of eight months from colonized (n = 104) and infected adults (n = 95). Serotypes and virulence determinants were detected by polymerase chain reactions (PCRs). Genetic relatedness was assessed using Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). Antimicrobial susceptibilities were determined by disk diffusion. Results: Serotypes III and V (25% each) were the most prevalent, followed by serotypes II (16.18%), Ia (13.24%), VI (9.31%), and Ib (8.82%), while five isolates remained non-typeable (2.45%). Hypervirulent serotype III/CC17 clone (n = 21) accounted for 41.18% of the serotype III isolates. Most isolates (53.92%) harboured pilus island (PI) 1 and 2a types, while PI-2b was predominantly detected in the hypervirulent clone. Isolates were variably resistant to tetracycline (76.47%), erythromycin (36.76%), clindamycin (25.49%), and levofloxacin (6.37%), but remained susceptible to penicillin. Macrolide resistant isolates exhibited constitutive (55.42%) and inducible macrolide-lincosamide-streptogramin B resistance phenotypes (33.74%), while a few had L (9.64%) or M (1.2%) phenotypes. MLVA patterns of dominant serotypes III and V revealed 40 different types divided into 12 clusters and 28 singletons. Interestingly, macrolide resistance was significantly associated with two major MLVA types. Conclusions: GBS isolates belonged predominantly to serotypes III and V, but there were no clear associations between serotypes and patient groups. The studied isolates exhibited high levels of resistance to erythromycin and clindamycin that need further surveillance