Novel markers in predicting Brucella sacroiliitis:The platelet large cell ratio and basal immature reticulocyte fraction

Objective:To present platelet large cell ratio(P-LCR),reticulocyte,and immature reticulocyte fraction(IRF)values as novel parameters in diagnosis and response to treatment in patients developing sacroiliitis.Methods:Sixty-eight patients with clinical symptoms and Brucella standard tube agglutination(Wright)or Brucella Coombs agglutination test titers≥1:160 were included in the study.Two groups were established,one developing sacroiliitis and another with no sacroiliitis development.P-LCR,reticulocyte,and IRF levels were measured using a Sysmex XN-9000 device(Japan).These were then compared between the two groups.Results:Reticulocyte(P=0.037)and IRF(P=0.026)levels were significantly lower among the patients developing sacroiliitis compared to the non-sacroiliitis group,while P-LCR(P=0.003)levels were significantly higher.P-LCR had the most powerful correlation with sacroiliitis development.Significant negative correlation was observed between reticulocyte,IRF levels and sacroiliitis.Conclusions:Elevated P-LCR levels were observed as a marker of persisting inflammation in patients developing sacroiliitis,while low reticulocyte and IRF levels secondary to bone marrow involvement were detected.These three parameters emerged as highly significant markers in terms of diagnosis and reflecting responses to treatment in organ involvement such as sacroiliitis in brucellosis.These are presented as inexpensive,and easily accessible novel parameters.

Tuberculous Sacroiliitis with Secondary Psoas Abscess: A Case Report

Tuberculous sacroiliitis secondary to a psoas abscess is rare, only a few sporadic cases were reported in the literature. Tuberculous sacroiliitis is rare, usually unilateral, its symptomatology is misleading, its diagnosis is often delayed or even confused with damage to the hip or lumbosacral hinge, most often related to difficulties exploration of the sacroiliac joint. We report the case of a 66-year-old diabetic patient with low back pain, unilateral right with inflammatory appearance, insidious installation, evolving for about 8 months. The diagnosis of tuberculous sacroiliitis was made after biopsy of the sacroiliac joint. CT and MRI are necessary for lesion diagnosis. Tuberculosis treatment was started and the abscess was surgically drained. The aim of this work was to describe the diagnostic pathway of a patient with tuberculous sacroiliitis in a tropical environment. Conclusion: Tuberculous sacroiliitis, secondary to an abscess of the psoas muscle is an unusual cause of hip pain and is likely to be overlooked due to its atypical presentation.

Brucellosis: An Outpatient Non-Probability Retrospective Study of 199 Patients

Background: A descriptive study of the characteristics of brucellosis patients in Jordan and antimicrobial therapy. Methods: In an outpatient study, records were reviewed between July 2016 and April 2024 and electronically saved. Brucella diagnosis was based on epidemiological factors, risk factors, the standard tube agglutination test (STA), and blood or tissue cultures. Records were uploaded into a spreadsheet and imported into the R-Program. A 2-sample Kruskal-Wallis rank sum tested the equality of proportions between two treatment regimens for all available and spondylodiscitis, P Results: Two hundred patients with Brucellosis were analyzed;males 106 (53%) with a mean age of 46.8 years, and females 94 (47%) with a mean age of 48.1 years. Patients from Jordan were 159 (79.9%), and the Arabian Peninsula 25 (12.6%). Brucellosis was a non-focal presentation in 121 (60.50%) patients, spondylodiscitis in 64 (32.0%), and sacroiliitis in 7 (3.5%). Spondylodiscitis involved lumbar 48 (75.0%), thoracic 11 (17.20%), and cervical 5 (7.8%). STA was a common diagnostic method (188, 94%). Risk factors included cheese 80 (47.3%), cattle, small ruminants, and she-camel milk 37 (21.89%), dairy products 28 (16.57%), meat 9 (05.33%), and working with cattle 10 (05.92%). ESR was highest in spondylodiscitis (mean of 54.5). Imaging studies commonly requested were MRI and Bone scans. Doxycycline/Rifampin were mostly prescribed antimicrobials. Conclusion: There is no clear guidance on brucella treatment. In endemic areas, brucella is still a concern. Population education must be a priority. Support for randomized trials addressing antimicrobials and durations is extremely needed.

Current issues in pediatric inflammatory bowel diseaseassociated arthropathies

Joint involvement is the most common extraintestinal manifestation in children with inflammatory bowel disease (IBD) and may involve 16%-33% of patients at diagnosis or during follow-up. It is possible to distinguish asymmetrical, transitory and migrating arthritis (pauciarticular and polyarticular) and spondyloarthropathy (SpA). Clinical manifestations can be variable, and peripheral arthritis often occurs before gastrointestinal symptoms develop. The inflammatory intestinal pattern is variable, ranging from sub-clinical inflammation conditions, classified as indeterminate colitis and nodular lymphoid hyperplasia of the ileum, to Crohn’s disease or ulcerative colitis. Unlike the axial form, there is an association between gut inflammation and evolution of recurrent peripheral articular disease that coincides with a flare-up of intestinal disease. This finding seems to confirm a key role of intestinal inflammation in the pathogenesis of SpA. An association between genetic background and human leukocyte antigen-B27 status is less common in pediatric than n adult populations. Seronegative sacroiliitis and SpA are the most frequent forms of arthropathy in children with IBD. In pediatric patients, a correct therapeutic approach relies on the use of nonsteroidal antiinflammatory drugs, local steroid injections, physiotherapy and anti-tumor necrosis factor therapy (infliximab). Early diagnosis of these manifestations reduces the risk of progression and complications, and as well as increasing the efficacy of the therapy.

Enteropathic spondyloarthropathy:A common genetic background with inflammatory bowel disease?

The association between spondyloarthropathy and in flammatory bowel disease(IBD) is largely established, although prevalence is variable because of different population selection and diagnostic methodologies.Most studies indicate that as many as 10%15% of cases of IBD are complicated by ankylosing spondylitis(AS) or other forms of spondylarthritis(SpA).Of note, ileal inflammation resembling IBD has been reported in up to two thirds of cases of SpA, and it has been suggested that the presence of ileitis is associated with the chronic ity of articular complications.Although this observation is of interest to unravel the pathophysiology of the disease, systematic screening of patients with SpA by ileocolonos copy is not indicated in the absence of gut symptoms, as only a small proportion of patients with subclinical gut inflammation will develop overt IBD over time.The existence of familial clustering of both IBD and AS, the coexistence of both conditions in a patient, the evidence of an increased risk ratio among f irstand seconddegree relatives of affected AS or IBD patients and f inally, the increased crossrisk ratios between AS and IBD, strongly suggest a shared genetic background.So far, however, IL23R is the only identified susceptibility gene shared by both IBD and AS.Although functional studies are still needed to better understand its pathogenic role, great ef fort is being spent therapeutically targeting this pathway that may prove effective for both disorders.

Concurrent ankylosing spondylitis and myelodysplastic syndrome:A case report

BACKGROUND Ankylosing spondylitis(AS)is an autoimmune disease characterized by sacroiliitis and spondylitis,with a few hematological abnormalities.Myelodysplastic syndromes(MDS)are a heterogeneous group of hematopoietic stem cell disorders with frequent autoimmune phenomena.The relationship between AS and MDS remains unknown.CASE SUMMARY We describe a rare case of concurrent AS and MDS.An 18-year-old man with low back pain and anemia was diagnosed with AS;however,the cause of anemia could not be determined by the first bone marrow examination.He recovered from anemia and the symptoms of AS resolved after treatment with etanercept,glucocorticoid,and blood transfusion,but he developed pancytopenia with an increased myeloblast count(from 2.5%to 9%).Chromosome analysis revealed del(7q)and trisomy 8.Refractory anemia with excess of blasts-1(RAEB-1)/MDS was confirmed by repeating the bone marrow examination.He became blood transfusion-dependent and received decitabine-based chemotherapy but eventually died.CONCLUSION We suspect that AS may be an early autoimmune phenomenon related to MDS.However,a condition of coexistence cannot be excluded.

Occurrence of human leukocyte antigen B51-related ankylosing spondylitis in a family:Two case reports

BACKGROUND Ankylosing spondylitis(AS)is strongly associated with the human leukocyte antigen(HLA)B27 haplotype.In regions where conventional polymerase chain reaction for HLA typing is available for antigens such as HLA B27 or HLA B51,it is common to perform the HLA B27 test for evaluation of AS.While HLA B27-associated clustered occurrences of AS have been reported in families,we report the first case series of HLA B51-related occurrences of AS in a family.CASE SUMMARY A father and his daughters were diagnosed with AS and did not have the HLA B27 haplotype.Although they were positive for HLA B51,they exhibited no signs of Behçet’s disease(BD).Of the five daughters,one had AS,and three,including the daughter with AS,were positive for HLA B51.The two daughters with the HLA B51 haplotype(excluding the daughter with AS)exhibited bilateral grade 1 sacroiliitis,whereas the daughters without the HLA B51 haplotype did not have sacroiliitis.Thus,this Korean family exhibited a strong association with the HLA B51 haplotype and clinical sacroiliitis,irrespective of the symptoms of BD.CONCLUSION It is advisable to check for HLA B51 positivity in patients with AS/spondyloarthropathy who test negative for HLA B27.

Case of gout with inflammatory low back pain

A 50-year-old male patient with a history of chronic tophaceous gout presented with low back pain and bilateral shoulder,hip,knee,and buttock pain for 1 year.He had nocturnal exacerbations of buttock pain and significant early morning stiffness,which improved with nonsteroidal anti-inflammatory agents(NSAIDs).On examination,he had multiple hard,lobulated tophaceous deposits over the bilateral elbow,hand,leg,and foot.There was no ulcer or discharge from tophi(Figure 1A).He had restriction of movements in the lower back and bilateral positive faber test localized to the back.