PMC6457016_01
T1-weighted image (T1WI) and gadolinium-enhanced T1-weighted image
(T1WI + Gad) (a) of the right hand at the time of the diagnosis of RA
(August 2014) and (b) of the wrist after cellulitis became apparent (April
2015). Note that the bone erosions became much more severe and that the
gadolinium-enhancing lesions became more diffuse in (b), suggesting the
presence of concomitant osteomyelitis.
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During the hospitalization, she developed bilateral polyarthritis of finger and hand joints and was diagnosed with seronegative rheumatoid arthritis (RA) in July (Figure 1(a)). The diffuse bone inflammation detected by magnetic resonance imaging (MRI) of the right wrist suggested the presence of osteomyelitis (Figure 1(b)). VCM was continued for 59 days. Two weeks before its cessation, oral MINO (50 mg, twice daily) was added.
Clinical course. While vancomycin (VCM) was administered, trough
concentrations were monitored. They were maintained within the range of
13-20 microg/mL, except on 2015/9/11 (32.1 microg/mL), after which the dosage of VCM
was reduced from 2 to 1.5 g/day.. IGT: iguratimod; PSL: prednisolone; TAC: tacrolimus; LZD: linezolid;
TAZ/PIPC: tazobactam/piperacillin; DAP: daptomycin; MINO: minocycline;
TMP-SMZ: trimethoprim-sulfamethoxazole; RFP: rifampicin; neutro: neutrophil;
lympho: lymohocyte; Plt: platelet.
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With the diagnosis of cellulitis, tazobactam/piperacillin (TAZ/PIPC, 4.5 g, three times a day) was administered the next day (Figure 2).
T1WI, T2WI, and T1WI + Gad of the thoracic vertebrae (a) at the time of the
diagnosis of spondylitis (July 2015) and (b) at the end of the treatment
(June 2016). The epidural abscess observed ranging from Th2 to Th10 (yellow
arrowheads in (a)) had almost disappeared in (b).
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Chest MRI was also performed and spondylitis in Th10 with an epidural abscess was discovered (Figure 3(a)).