Allergic dermatitis after knee arthroscopy with repeated exposure to Dermabond Prineo™ in pediatric patients: Two case reports

BACKGROUND

Allergic contact dermatitis (ACD) secondary to Dermabond Prineo™ is rare, but documented. To our knowledge, there are no described reports of this ACD reaction within the pediatric population following arthroscopic surgery.

CASE SUMMARY

We report two cases of pediatric ACD upon second exposure to Dermabond Prineo™ after knee arthroscopy. Both cases presented within two weeks of the inciting second exposure. The cases resolved with differing described combinations of sterile cleaning, diphenhydramine, and antibiotic administration. No long-term sequelae were found.

CONCLUSION

This case report elucidates the rare complication of allergic dermatitis secondary to Dermabond Prineo™ repeat exposure use in pediatric arthroscopy.

Atypical Mycobacterial Infections of the Upper Extremity

Atypical mycobacterial infections of upper extremity synovial-lined structures are often misdiagnosed and unrecognized. Despite an increasing incidence, lack of physician awareness of these pathogens may result in considerable delay in diagnosis and management, potentially leading to permanent disability. The authors conducted a literature review and analyzed 31 cases of penetrating atypical mycobacterial infection to better understand the clinical characteristics and to evaluate their posttreatment complication rate compared with available literature. Medical records for culture-positive cases of tenosynovial or intra-articular atypical mycobacterial infections of the upper extremity that were treated were retrospectively reviewed. Treatment outcomes were analyzed against published case reviews and case series. Thirty-one cases of penetrating atypical mycobacterial infection were identified. Mycobacterium marinum (n=11) was the most common organism and was associated with aquatic exposure. Twenty-eight cases received empiric treatment, 17 of which received contraindicated treatment. Patients saw an average of 5 physicians prior to receiving an accurate diagnosis, and the mean time to diagnosis was 10 months. All cases received antibiotic treatment in addition to surgical management. Twenty cases (68%) failed treatment outcomes. Delay in diagnosis and inappropriate management of atypical mycobacterial infections may lead to a treatment failure rate that is higher than what has been reported in the literature. Mycobacterium avium and M fortuitum had significantly higher failure rates than other organisms. A high index of suspicion is required to make a diagnosis and prevent residual disability. [Orthopedics. 2018; 41(3):e383-e388.].

Radio-iodine treatment of hyperthyroid cats

Thirty-two elderly domestic shorthaired cats (mean age 12.9 years) were treated with radioiodine (131I). The dose of 131I administered ranged from 39 mBq to 134 mBq. Twenty-eight cats became euthyroid after treatment, one became hypothyroid and three remained hyperthyroxaemic. Two of the hyperthyroxaemic cats were successfully re-treated with 131I. Five cats died from concurrent diseases within one year of treatment. The administration of a dose of 131I selected by assessing the severity of the clinical signs, the size of the thyroid gland(s) and the serum level of thyroxine was an effective treatment for hyperthyroidism.

Splenic scintigraphy: a large congenital fissure mimicking splenic hematoma

This report describes a case of blunt abdominal trauma in which a deep congenital fissure in the superior border of the spleen led to the preoperative scintigraphic diagnosis of a splenic hematoma. The frequency of splenic notches of this magnitude is low but significant, hence anatomical variation should be considered in the differential diagnosis of scintigraphic defects.

Undetected latrogenic hypothyroidism: a late complication of radio-iodine therapy

The thyroid status of 317 patients treated with radioactive iodine between 1951 and December 1971 was investigated. Information was obtained on 236 patients and hypothyroidism, either treated or untreated, was present in 48 percent of women and 37 percent of men at mean follow-up intervals of 5.5 and 4.4 years respectively. Ninety-four of the 241 patients still alive were assessed personally by clinical examination and serum thyroxine assay, and 10 were found to have previously undiagnosed hypothyroidism. Seven of these patients had symptoms and in five these symptonms were the cause of significant distress. The importance of undertaking a long term review programme following radioactive iodine therapy is emphasised.