Douglas S. Katz

Mycobacterium bovis vertebral osteomyelitis and psoas abscess after intravesical bcg therapy for bladder carcinoma

Systemic complications of intravesicular BCG for bladder carcinoma are uncommon, and include fever, pneumonia, hepatitis, arthralgias, or skin rash. Local complications of BCG therapy for bladder cancer include cystitis, prostatitis, epididymo-orchitis, granulomatous lymphadenitis, or ureteral obstruction. We believe this is the first case of Mycobacterium bovis vertebral osteomyelitis and psoas abscess complicating intravesicular BCG therapy for bladder carcinoma.

Clostridium perfringens emphysematous cystitis

Emphysematous cystitis is a rare disease and is usually caused by aerobic bacteria, most commonly Escherichia coli. Only rarely have anaerobic bacteria been associated with this condition. We report a case of emphysematous cystitis due to Clostridium perfringens with bacteremia in an elderly diabetic woman.

A rare case of cerebellar glioblastoma multiforme in childhood: MR imaging

Glioblastoma multiforme is a highly malignant brain neoplasm that is very rarely discovered in childhood but accounts for approximately 17% of intracranial tumors in the adult. Only approximately 25 children with glioblastoma multiforme in the cerebellum have been described in the literature. We report on a 4 1/2-year-old girl with this tumor in the cerebellar hemisphere and discuss the magnetic resonance imaging findings.

Pulmonary artery laceration and tension pneumothorax in blunt chest trauma.

Traumatic laceration of the pulmonary artery is rare and is associated with a high mortality rate. The article describes a patient with pulmonary artery laceration from blunt chest trauma who presented with tension pneumothorax. Potentially life-threatening intrathoracic bleeding was not apparent until the pneumothorax was decompressed.

Fever of unknown origin (FUO) and a renal mass: renal cell carcinoma, renal tuberculosis, renal malakoplakia, or xanthogranulomatous pyelonephritis?

Often patients with fevers of unknown origin (FUOs) present with loss of appetite, weight loss, and night sweats, without localizing signs. Some are found to have a renal mass during diagnostic evaluation. In patients with FUOs and a renal mass, the differential diagnosis includes renal tuberculosis, renal cell carcinoma (hypernephroma), renal malakoplakia, and xanthogranulomatous pyelonephritis. A 68-year-old woman presented with an FUO during her diagnostic workup. She manifested an irregularly enlarged kidney on abdominal computed tomography (CT) scan, as well as a highly elevated erythrocyte sedimentation rate of more than 100 mm/hour, an elevated serum ferritin level, and chronic thrombocytosis, which favored a diagnosis of renal cell carcinoma. Renal malakoplakia and renal tuberculosis comprised further differential diagnostic considerations. Microscopic hematuria may be present with any of the disorders in the differential diagnosis, but was absent in this case. An abdominal CT scan was suggestive of xanthogranulomatous pyelonephritis. Because of concerns regarding renal cell carcinoma, the patient received a nephrectomy. The pathologic diagnosis was of xanthogranulomatous pyelonephritis, without renal cell carcinoma.

Fever of unknown origin (FUO) due to a solitary cavitary lung lesion: The deadly ferritin-laced doughnut

Fever of unknown origin (FUO) is the clinical designation for patients who have fevers >101F that have persisted for >3 weeks that remain undiagnosed, after an intensive ambulatory/in-hospital workup. Fevers of unknown origin may be due to wide variety of infectious, neoplastic, or rheumatic/inflammatory disorders. The most common causes of FUOs in elderly patients are infectious and neoplastic diseases. With FUOs, the clinical presentation and routine laboratory tests are usually sufficient to narrow differential diagnostic possibilities. We present a case of an elderly Italian woman who presented with an FUO and a solitary, thick-walled cavitary lesion on chest x-ray (CXR). The infectious disease differential diagnosis of her FUO included lung abscess, M. tuberculosis (TB), systemic mycoses, and echinococcal-cyst (or hydatid-cyst) disease. The malignancy and neoplastic differential diagnosis included bronchogenic carcinoma, lymphoma, and metastatic carcinoma. Her nonspecific laboratory tests indicated a highly elevated erythrocyte sedimentation rate (ESR) >100 mm/hour, chronic thrombocytosis, relative lymphopenia, and highly elevated serum ferritin levels. Excluding highly elevated serum ferritin levels, the differential diagnosis of her FUO with a solitary, thick-walled cavitary lesion was lung abscess vs tuberculosis. However, her highly elevated serum ferritin levels proved to be the critical diagnostic clue in predicting the diagnosis of squamous-cell carcinoma. We conclude that serum ferritin levels are an important part of the laboratory workup. As with other nonspecific laboratory tests, the diagnostic significance of highly elevated ferritin levels depends associated clinical features in the clinical presentation.

An 18-month-old girl with a liver mass

An 18-month-old girl presented with an abdominal mass, detected by her mother. Seven days later, the child was admitted to University Hospital, State University of New York Health Science Center at Syracuse; her other medical history was noncontributory. On physical examination a firm, irregular, nontender, fist-sized mass was palpable in the right upper abdominal quadrant just below the costal margin. The remainder of the abdomen was soft and nontender, with normal bowel sounds. The physical examination was otherwise unremarkable. Laboratory data included a serum a-fetoprotein level of 20,800 ng/ml (normal < 30 ng/ml). The CBC, SMA12, and liver function tests were normal.

A 24-year-old man with diplopia and frontal headache

Six weeks prior to admission, diplopia and frontal headache developed in a 24year-old man with no significant medical history. He also complained of slight tin&us in the left ear at night, decreased appetite, and an 8-lb weight loss over the previous week. On examination papilledema was noted, greater on the left than the right. Extraocular movements were intact. The neurological examination was otherwise unremarkable. Results of routine laboratory tests on admission were normal. Magnetic resonance (MR) imaging of the brain at an outside institution revealed a mass in the right lateral ventricle. Oral treatment with dexamethasone (Decadron) was begun, and the patient was admitted to University Hospital, State University of New York Health Science Center at Syracuse. After cerebral angiography, the patient underwent a right frontal craniotomy and resection of the mass.

A 12-year-old girl with a bladder mass

A ly urinalysis also revealed proteinuria and ketonuria. The hemoglobin and hematocrit were 10.6 and 32.9. Blood urea nitrogen (BUN) and creatinine were normal.