Pneumococcal Pyomyositis: A Patient with Diagnostic Problems and Complications

Pyomyositis is an uncommon condition that may present a difficult problem in diagnosis. We report the development of Streptococcus pneumoniae pyomyositis involving the iliacus, iliopsoas, and gluteus muscles in a patient with elevated serum levels of antinuclear and antiphospholipid antibodies but without clinical evidence of connective tissue disease. Magnetic resonance imaging demonstrated rapid evolution of the infection, with progression from muscle edema to abscess formation over a period of 10 days. The diagnosis was initially missed, and osteomyelitis and sacroiliitis developed. Pyomyositis should be suspected in patients with the acute onset of severe, localized muscle pain and fever. As in this case, failure to promptly diagnose and treat this infection can result in significant morbidity.

Effect of sodium salicylate, aspirin, and ibuprofen on enzymes required by the chondrocyte for synthesis of chondroitin sulfate

OBJECTIVE

To examine the effects of sodium salicylate (Sal), aspirin [acetylsalicylic acid (ASA)] and ibuprofen (Ibu) (as the racemic mixture and the R- and S-enantiomers) on the activities of 2 enzymes involved in the biosynthesis of the hexose components of chondroitin sulfate (CS), i.e., UDP-glucose dehydrogenase (UDP-GD) and glutamine-fructose-6-phosphate-aminotransferase (GFAT), and of glucuronosyltransferase (GT), an enzyme involved in elongation of the nascent CS chain.

METHODS

UDP-GD and GT were obtained commercially. A homogenate of bovine articular cartilage chondrocytes was employed as a source of GFAT. In each case, enzymatic activity was measured spectrophotometrically.

RESULTS

Neither UDP-GD nor GFAT was inhibited by concentrations of Sal, ASA or Ibu that were achieved clinically in joint tissues (e.g., 1.0 mM Sal and ASA, 170 microM Ibu). In contrast, GT activity was inhibited by Sal and ASA in a concentration dependent fashion; at 1.0 mM, a concentration commonly reached in synovial fluid of patients treated with an antiinflammatory dose of the drug, GT activity in the presence of Sal and ASA was 54% (p = 0.001) and 75% (p = 0.05), respectively, of the control value. In contrast, a clinically relevant concentration of Ibu had no effect on GT activity.

CONCLUSION

Salicylates may suppress cartilage proteoglycan synthesis by inhibiting GT.

Suppression of glycosaminoglycan synthesis by articular cartilage, but not of hyaluronic acid synthesis by synovium, after exposure to radiation

We recently found that injection of 2 mCi of yttrium 90 (90Y; approximately 23,000 rads) into normal canine knees stimulated glycosaminoglycan (GAG) synthesis by femoral condylar cartilage. The present investigation was conducted to determine whether radiation affects cartilage metabolism directly. Rates of GAG synthesis and degradation in normal canine articular cartilage were studied following irradiation. Cultured synovium from the same knees was treated similarly, to determine the effects of irradiation on hyaluronic acid synthesis. Twenty-four hours after exposure to 1,000 rads, 10,000 rads, or 50,000 rads, 35S-GAG synthesis by the cartilage was 93%, 69%, and 37%, respectively, of that in control, nonirradiated cartilage. The effect was not rapidly reversible: 120 hours after exposure to 50,000 rads, GAG synthesis remained at only 28% of the control level. Autoradiography showed marked suppression of 35S uptake by chondrocytes after irradiation. Cartilage GAG degradation was also increased following irradiation: 4 hours and 8 hours after exposure to 50,000 rads, the cartilage GAG concentration was only 66% and 54%, respectively, of that at time 0, while corresponding values for control, nonirradiated cartilage were 90% and 87%. In contrast to its effects on cartilage GAG metabolism, radiation at these levels had no effect on synovial hyaluronic acid synthesis.