ro13-9904 and Movement-Disorders

Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Ghana; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Movement Disorders; Neisseria gonorrhoeae; Travel; Treatment Outcome; United Kingdom

A case of oculofacial-skeletal myorhythmia associated with cerebral Whipple's disease is presented. This peculiar abnormal movement disorder consists of a convergent-divergent pendular nystagmus associated with a synchronous, rhythmic movement of the mouth, jaw, and extremities. The movements in previous cases have responded inconsistently to a variety of broad-spectrum antibiotic drugs, and antiepileptic, muscle relaxant, antispastic, and psychotropic drugs. The current patient's mental status improved after starting intravenous ceftriaxone but improvement of the abnormal movements occurred only after the addition of oral valproate. Current treatment consists of intravenous trimethoprim-sulfamethoxazole for 2 weeks followed by oral trimethoprim-sulfamethoxazole twice daily for 1 year. Presented here is an alternative treatment of intravenous ceftriazone followed by oral trimethoprim-sulfamethoxazole in combination with valproate for abnormal movements not responsive to antibiotic drugs alone.

Topics: Adult; Ceftriaxone; Follow-Up Studies; Humans; Male; Movement Disorders; Oculomotor Muscles; Sulfamethoxazole; Treatment Outcome; Trimethoprim; Valproic Acid; Whipple Disease

A 9-year-old boy admitted to a district general hospital with a 1-week history of fever and a 2-day history of right hip pain. Initial workup revealed raised inflammatory markers and unremarkable imaging studies. After clinical review, there was minimal improvement of the patient's condition 5 days after presentation; therefore, an MRI of the pelvis/hips was carried out, which supported a clinical diagnosis of right-sided infective sacroiliitis. Infective sacroiliitis is rare and only represents 1%-2% of septic arthritis in children. The condition still remains a diagnostic challenge first due to poor localisation of symptoms with referred pain to the hip, thigh and lower back and second due to a lack of awareness by non-specialist clinicians. Early diagnosis is a key to avoid sequelae such as an abscess, degenerative changes of the sacroiliac joint and can be achieved by a thorough clinical examination, monitoring inflammatory markers and MRI.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Child; Diagnosis, Differential; Hip; Humans; Magnetic Resonance Imaging; Male; Movement Disorders; Pain; Rare Diseases; Sacroiliac Joint; Sacroiliitis; Treatment Outcome

Topics: Adult; Amnesia; Ceftriaxone; Humans; Male; Movement Disorders; Nystagmus, Pathologic; Whipple Disease