1. bookVolume 26 (2020): Issue 2 (May 2020)
Journal Details
License
Format
Journal
First Published
16 Feb 2013
Publication timeframe
4 times per year
Languages
English
access type Open Access

Complex Polypathology Infectious, Rheumatological, Neurological and Orthopedic – Real Challenge for Functional Rehabilitation - Case Report

Journal Details
License
Format
Journal
First Published
16 Feb 2013
Publication timeframe
4 times per year
Languages
English
Abstract

Introduction. Infectious and autoimmune rheumatic diseases (ARDs) are closely linked. Apart from the challenging, sometimes differential, diagnosis between these conditions, it is recognized that microbes play an important role in the pathogenesis of the latter. Material and method. We present the case of a 45-year-old female patient from our rehabilitation department, with complex pathology (infectious, neurological, rheumatological and orthopedic pathology) that began more than 15 years ago. The patient’s pathological history began insidiously at theage of 30 when she was diagnosed with neurotoxoplasmosis. She received anticoagulant, antiepileptic, steroidal, antibiotic and antihelmintic treatment. After four years, the patient shows insidious onset of inflammatory pain in the large joints and in 2010 is diagnosed with seropositive rheumatoid arthritis, according to American College of Rheumatism/European League against rheumatism (ACR/EULAR) criteria with symmetric impairment of the large joints (shoulder, elbow, hip, knee, ankle). Despite the treatment with disease-modifying anti-rheumatic drugs (DMARDs) received, in the following years she needed 4 arthroplasties in the large joints due to osteonecrosis. Conclusions. On clinical grounds, infections, especially chronic infections, can cause a plethora of autoimmune phenomena, thus mimicking ARDs. Therefore, the differential diagnosis between ARDs and infectious diseases is sometimes challenging as they often display similar clinical manifestations. It is highlighted that the immune system can be our friend or our foe considering that its function and dysregulation are the common denominators in autoimmune and infectious diseases. In the era of new drugs and new therapeutic strategies, safety of the patients should always be our first concern.

Keywords

1. Fragoulis GE, Sipsas N V. When rheumatology and infectious disease come together. Vol. 11, Therapeutic advances in musculoskeletal disease. SAGE Publications Ltd; 2019. p. 1–3. Search in Google Scholar

2. Lafforgue P. Pathophysiology and natural history of avascular necrosis of bone. Jt bone spine. 2006 Oct;73(5):500–7. Search in Google Scholar

3. Moreira-Silva SF, Rodrigues MG, Pimenta JL, Gomes CP, Freire LH, Pereira FEL. Toxocariasis of the central nervous system: with report of two cases. Rev Soc Bras Med Trop. 2004;37(2):169–74. Search in Google Scholar

4. Finsterer J, Auer H. Neurotoxocarosis. Rev Inst Med Trop Sao Paulo. 2007;49(5):279–87. Search in Google Scholar

5. Jones J, Kruszon-Moran D, Won K, Wilson M, Schantz P. Toxoplasma gondii and Toxocara spp. co-infection. Am J Trop Med Hyg. 2008;78(1):35–9. Search in Google Scholar

6. Stanbury RM, Graham EM. Systemic corticosteroid therapy-side effects and their management. Br J Ophthalmol. 1998 Jun;82(6):704–8. Search in Google Scholar

7. Akyol A, Bicerol B, Ertug S, Ertabaklar H, Kiylioglu N. Epilepsy and seropositivity rates of Toxocara canis and Toxoplasma gondii. Seizure. 2007 Apr;16(3):233–7. Search in Google Scholar

8. Dentali F, Crowther M, Ageno W. Thrombophilic abnormalities, oral contraceptives, and risk of cerebral vein thrombosis: A meta-analysis. Blood. 2006 Apr 1;107(7):2766–73. Search in Google Scholar

9. Zabinski S, Sculco T, Dicarlo E, Rivelis M. Osteonecrosis in the rheumatoid femoral head. J Rheumatol. 1998;25(9):1674–80. Search in Google Scholar

10. Li W-L, Tan B, Jia Z-X, Dong B, Huang Z-Q, Rui-ZhengZhu, et al. Exploring the Risk Factors for the Misdiagnosis of Osteonecrosis of Femoral Head: A Case-Control Study. Orthop SurgDec. 2020;12(6):1792-1798. Search in Google Scholar

11. Toma A-A, Ghinguleac IB, Ghinguleac LA, Calota ND, Oprea D, Ionescu EV, et al. Case presentation: The interdisciplinary and rehabilitation treatment of lumbar disc hernia on a patient with corticoterapy dependency and history of lymph node TB. Balneo Res J. 2020;11(4):556–60. Search in Google Scholar

12. Oprea D, Jimbu D, Ionescu EV, Iliescu MG, Stanciu LE, Oprea C. Uveitis – Possible adverse reaction to secukinumab in a patient with rehabilitation treatment for ankylosing spondylitis (case report). Balneo Res J. 2020 Dec 5;(Vol.11, 4):561–5. Search in Google Scholar

13. Anton A, Gherghisan IS, Omer (Gheorghe) A, Ionescu EV, Iliescu MG, Baz R. Challenges in multidisciplinary medical rehabilitation - Swyer-James-MacLeod Syndrome: case presentation and short literature review. Balneo Res J. 2019 Dec 10;10(4):457–61. Search in Google Scholar

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