Epithelioid Hemangioma Involving Three Contiguous Bones: a Case Report with a Review of the Literature

An epithelioid hemangioma involving three contiguous bones in continuity has, to the best of our knowledge, not been reported in the literature. A case of a 48-year-old man presented with radiating pain to the lower thoracic region for two years. A radiograph and CT scan revealed both permeative osteolytic and multiple trabeculated lesions involving the left posterior part of the 10th rib as well as the 9th and 10th vertebral bodies in continuity and was misled as a malignant or infectious lesion. The histopathology and immuno-histochemistry of the lesion confirmed the diagnosis of an epithelioid hemangioma. The lesion was still stable as of three years after surgery

Long-term outcomes and predictors of biologic treatment in systemic juvenile idiopathic arthritis in a single-center experience in Thailand

Background: The outcomes of systemic juvenile idiopathic arthritis (SJIA) vary from mild disability to mortality. Due to the socioeconomic problems in Thailand, the delay in receiving some medications, especially biologic agents, might affect the outcomes of this disease. This study aimed to determine the long-term outcomes and predictors of biologic treatment in SJIA patients. Methods: Patients with SJIA were enrolled over the study period between April 1997 and January 2015. The data were collected from medical records at the initial presentation and the most recent clinical visit. Outcomes evaluated included disease status, functional impairment, and joint destruction. Results: Of the 68 SJIA patients, 64 (94%) were eligible. The median (interquartile range) age at disease onset and duration of follow-up were 4.4 (2.9–7.9) and 4.2 (2.3–5.9) years, respectively. Nine patients (14%) achieved complete remission, while 12 (18.8%) had persistent active disease and 3 patients died; 2 of them had macrophage activation syndrome, while the other had a severe infection. A predictor of moderate-to-severe disability (childhood health assessment questionnaire ≥0.75) was hip involvement (odds ratios [OR] 27, 95% confidence interval [CI] 3.20–228.05). In addition, the predictors of biologic treatment were female gender (OR 6.4, 95% CI 1.74–23.74), younger age of onset (OR 4.7, 95% CI 1.31–16.66), hepatosplenomegaly (OR 5.9, 95% CI 1.29–27.29), and positive antinuclear antibody (ANA) (OR 6.3, 95% CI 1.19–33.75). Bone erosion was found in 34.2% of SJIA patients. Conclusion: Hip involvement was the important predictor of moderate-to-severe disability in SJIA, whereas female gender, younger age of onset, hepatosplenomegaly, and positive ANA were the predictors of biologic treatment

Patient demographics.

BackgroundMicrobiological diagnosis of tuberculous spondylodiscitis (TS) and pyogenic spontaneous spondylodiscitis (PS) is sometime difficult. This study aimed to identify the predictive factors for differentiating TS from PS using clinical characteristics, radiologic findings, and biomarkers, and to develop scoring system by using predictive factors to stratify the probability of TS.MethodsA retrospective single-center study. Demographics, clinical characteristics, laboratory findings and radiographic findings of patients, confirmed causative pathogens of PS or TS, were assessed for independent factors that associated with TS. The coefficients and odds ratio (OR) of the final model were estimated and used to construct the scoring scheme to identify patients with TS.ResultsThere were 73 patients (51.8%) with TS and 68 patients (48.2%) with PS. TS was more frequently associated with younger age, history of tuberculous infection, longer duration of symptoms, no fever, thoracic spine involvement, ≥3 vertebrae involvement, presence of paraspinal abscess in magnetic-resonance-image (MRI), well-defined thin wall abscess, anterior subligamentous abscess, and lower biomarker levels included white blood cell (WBC) counts, erythrocyte-sedimentation-rate (ESR), neutrophil fraction, and C-reactive protein (all p 3 (odds ratio [OR] 13.11, 95% confidence interval [CI] 4.23–40.61), neutrophil fraction ≤78% (OR 4.93, 95% CI 1.59–15.30), ESR ≤92 mm/hr (OR 4.07, 95% CI 1.24–13.36) and presence of paraspinal abscess in MRI (OR 10.25, 95% CI 3.17–33.13), with an area under the curve of 0.921. The scoring system stratified the probability of TS into three categories: low, moderate, and high with a TS prevalence of 8.1%, 29.6%, and 82.2%, respectively.ConclusionsThis prediction model incorporating WBC, neutrophil fraction counts, ESR and presence of paraspinal abscess accurately predicted the causative pathogens. The scoring scheme with combination of these biomarkers and radiologic features can be useful to differentiate TS from PS.</div

STROBE statement—checklist of items that should be included in reports of observational studies.

STROBE statement—checklist of items that should be included in reports of observational studies.</p

Radiologic findings in tuberculous and pyogenic spondylodiscitis.

Radiologic findings in tuberculous and pyogenic spondylodiscitis.</p

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BackgroundMicrobiological diagnosis of tuberculous spondylodiscitis (TS) and pyogenic spontaneous spondylodiscitis (PS) is sometime difficult. This study aimed to identify the predictive factors for differentiating TS from PS using clinical characteristics, radiologic findings, and biomarkers, and to develop scoring system by using predictive factors to stratify the probability of TS.MethodsA retrospective single-center study. Demographics, clinical characteristics, laboratory findings and radiographic findings of patients, confirmed causative pathogens of PS or TS, were assessed for independent factors that associated with TS. The coefficients and odds ratio (OR) of the final model were estimated and used to construct the scoring scheme to identify patients with TS.ResultsThere were 73 patients (51.8%) with TS and 68 patients (48.2%) with PS. TS was more frequently associated with younger age, history of tuberculous infection, longer duration of symptoms, no fever, thoracic spine involvement, ≥3 vertebrae involvement, presence of paraspinal abscess in magnetic-resonance-image (MRI), well-defined thin wall abscess, anterior subligamentous abscess, and lower biomarker levels included white blood cell (WBC) counts, erythrocyte-sedimentation-rate (ESR), neutrophil fraction, and C-reactive protein (all p 3 (odds ratio [OR] 13.11, 95% confidence interval [CI] 4.23–40.61), neutrophil fraction ≤78% (OR 4.93, 95% CI 1.59–15.30), ESR ≤92 mm/hr (OR 4.07, 95% CI 1.24–13.36) and presence of paraspinal abscess in MRI (OR 10.25, 95% CI 3.17–33.13), with an area under the curve of 0.921. The scoring system stratified the probability of TS into three categories: low, moderate, and high with a TS prevalence of 8.1%, 29.6%, and 82.2%, respectively.ConclusionsThis prediction model incorporating WBC, neutrophil fraction counts, ESR and presence of paraspinal abscess accurately predicted the causative pathogens. The scoring scheme with combination of these biomarkers and radiologic features can be useful to differentiate TS from PS.</div

Scoring scheme of prediction model to differentiate tuberculous spondylodiscitis from pyogenic spontaneous spondylodiscitis.

Scoring scheme of prediction model to differentiate tuberculous spondylodiscitis from pyogenic spontaneous spondylodiscitis.</p

A 53-year-old woman with infectious spondylodiscitis.

a) Sagittal T1-weighted MRI scan demonstrates L2–L4 hypointensity with anterior subligamentous spreading at L2–L3. b) Sagittal T2-weighted MRI scan demonstrates L2–L4 inhomogeneous hyperintensity. c) Sagittal T1-weighted gadolinium-enhanced MRI scan demonstrates focal inhomogeneous at L2–L3 and intraosseous rim enhancement. d) Axial T1-weighted gadolinium-enhanced MRI scan demonstrates a well-defined paraspinal abscess (white arrow) at L3 level. The patient’s laboratory data were as follows: WBC ≤ 9,700/mm3, neutrophil fraction ≤ 78%, and ESR ≤ 92 mm/h. Using the scoring scheme, the patient’s score was 10 + 13 + 5 + 4 = 32; indicating a high probability of tuberculous spondylodiscitis. MRI = magnetic resonance imaging, WBC = white blood cell, ESR = erythrocyte sedimentation rate.</p

Flow diagram of patient selection.

SIS = spontaneous infectious spondylodiscitis, TS = tuberculous spondylodiscitis, PS = pyogenic spondylodiscitis. Iatrogenic spondylodiscitis was defined as spinal infection associated with prior surgical or interventional procedure that entered the spinal area.</p