Tropical Medicine Mission Index of Diseases About Tropical Medicine Tropical Medicine Home Page Tropical Medicine Staff

 

 

 

Fig. 6.10 A-G. A 28-year-old Indian from southern India came to hospital with multiple swellings of the left chest wall. A There were multiple sinuses surrounded by heaped-up granulomatous tissue due to nocardiosis. B Underlying the soft tissue swelling there was periosteal new bone formation around the clavicles and scapula and some destructive areas in the scapula. There was a pleural effusion under the left upper lobe. C Three months later the infection is worse. The left ribs are involved, the clavicles show prolific periosteal new bone formation, there is sclerosis in the scapula as well as areas of destruction, and the pleural thickening and pleural effusion have increased. There is probably infection in the underlying lung. D The macroscopic specimen of the lung of a different patient with a similar nocardial infection in the, upper lobe. E A similar nocardial brasiliensis infection in a patient from South America. In the early stages the outer end of the clavicle shows some periosteal thickening and the scapula is increased in density, with some lytic areas underlying the soft tissue swelling. F Later the reaction on the clavicle is more marked and the soft tissue swelling has increased. G The right shoulder of a different patient from South America. The whole length of the humerus shows periosteal reaction and multiple lytic areas which have probably spread from the tissue infection around the shoulder and scapula. In this patient the clavicle has remained normal. (E-G courtesy of Professor Harold Jacobson and Dr. Ceballas Labat)

Fig. 6.11 A, B. Nocardia affects vertebral bodies the same way as other parts of the skeleton. There are areas of destruction and exuberant new bone formation, but osteoporosis is less common. A Anteroposterior and B lateral view of the lumbosacral region in a 35-year-old Indian woman who had mistakenly received treatment for tuberculosis. The multiple sinuses which developed allowed a more accurate diagnosis. There is periosteal new bone formation, sclerosis, and partial collapse of several vertebral bodies. There are multiple lytic lesions near the sacroiliac joints. Treatment for nocardiosis provided remarkable clinical improvement and the sinuses dried up after a few months.

 

 

Next Page

 

 

Fig. 6.11 A, B. Nocardia affects vertebral bodies the same way as other parts of the skeleton. There are areas of destruction and exuberant new bone formation, but osteoporosis is less common. A Anteroposterior and B lateral view of the lumbosacral region in a 35-year-old Indian woman who had mistakenly received treatment for tuberculosis. The multiple sinuses which developed allowed a more accurate diagnosis. There is periosteal new bone formation, sclerosis, and partial collapse of several vertebral bodies. There are multiple lytic lesions near the sacroiliac joints. Treatment for nocardiosis provided remarkable clinical improvement and the sinuses dried up after a few months.

Fig. 6.12 A-E. Nocardial infections of the arm, wrist, and fingers. A Specimens of amputated fingers from a patient in India: there are multiple discharging sinuses. B The typical exuberant periosteal new bone formation without sequestration: the periosteal new bone and the cortex are perforated by multiple 4 to 7-mm lytic areas. This decompression prevents formation of a sequestrum because the vascular supply to the cortex and the periosteum is maintained. (See Fig. 6.18 C-E). C Histology of the finger showing lacy (cabbage leaf) periosteal new bone. The fungal abscess perforates through the cortex and periosteum, permitting free drainage from the infected bone. D Multiple areas of destruction are typical of nocardial infections, as seen here in the lower end of the humerus and the proximal ulna. The same patient had similar areas of destruction near both wrist joints, with marked soft tissue swelling on the right wrist in particular. This clinically might suggest tuberculosis before the sinuses develop. The periosteal reaction of nocardiosis is proliferative with reactive sclerosis, unlike the osteoporosis of tuberculosis. E The end result of incompletely treated nocardiosis. The periosteum has consolidated and the bones have remodeled and become sclerosed, superimposed on the multiple areas of bone and joint destruction.

 

 

Back to the Table of Contents

Copyright: Palmer and Reeder