by Based on this case, early recognition of reactive arthritis is usually of major importance to avoid delayed initiation of appropriate treatment in the patients with polyarthritis secondary to neurogenic bladder following cauda equina injury after spine fracture. == 1. do not present with this classic triad [2]. Neurogenic bladder (NB) is usually often associated with spinal cord diseases or cauda equina injury after spine fracture but may also be caused by brain diseases or peripheral nerve diseases. The urological complications of NB consist of an inability to vacant the bladder, as well as urinary tract infections, incontinence, and upper tract deterioration. Urinary tract infection is usually a common problem among patients with spinal cord injury (SCI) accounting for 50% of nosocomial infections in some international studies [3]. The overall rate of urinary contamination in SCI patient is about 2.5 episodes per patient per year [4]. Reviewing literatures, neurogenic bladder in populace with spinal cord injury or cauda equina injury has been well acknowledged, but reactive arthritis resulting from spinal cord injury or cauda equina injury is very uncommon. This is the first report of the clinical course of a patient with reactive arthritis secondary to neurogenic bladder following cauda equina injury in China. The diagnostic and therapeutic approach to the patient and ML-098 details of its evolution are presented below. == 2. Case Report == A 38-year-old man was admitted to our hospital complaining of a one-month history of muscle weakness and dysesthesia in the lower extremities, urinary retention Rabbit Polyclonal to SNAP25 accompanied with urinary tract contamination on January ML-098 14, 2011. He fell from the second floor of a block of flats on December 2, 2010 and plain radiograph of the thoracolumbar spine revealed a comminuted, burst fracture of L1and L2. Then emergency surgical treatment was performed for removal of intradural space-occupying lesion and decompression of cauda ML-098 equina. In spite of this, he had the onset of urinary retention, muscle weakness, and dysesthesia in the lower extremities resulting from damage to the cauda equine after operation. During further rehabilitation in community hospital, the urinary tract infection developed. The laboratory investigation showed white blood cell (WBC) in the urinewas higher than the normal level. After treatment with oral antibiotic, the urinary tract contamination improved. He was hospitalized in our department for further treatment and the diagnosis of cauda equine injury with neurogenic bladder was based on laboratory and clinical information below. Upon admission, his body temperature was 36.7C, pulse rate was regular, 78 beats/min, and blood pressure was 120/78 mmHg. The neurologic examination was compatible with a cauda equine lesion: there was hypesthesia at left L1and right L2sensory dermatome, hyporeflexia knee and ankle jerks, no anal sphincter contraction, and bulbocavernosus reflex. His white blood count was 6.99/L, hemoglobin 126 g/L, and platelets 250/L. Differential count showed 69.5% neutrophils, 20.7% lymphocytes, 6.7% monocytes, 2.7% eosinophils, and 0.4% basophils. White blood cell count in the urine was 1169/L (normal range 0~12/L). On X-ray of the thorax, knee, feet, and ankles, no abnormalities were observed. Ultrasonography revealed that there was residual urine in the bladder and the volume was higher than ML-098 normal (>150 mL). Because of the neurogenic bladder, he was subjected to a series of treatments including intermittent urethral catheterization and different bladder management methods (Valsalva, Crede, and reflex voiding). A microscopic urine analysis revealed WBC, and bacterial colony counts were still higher than the normal level. It suggested that this urinary contamination were not completely curable. And then the patient was treated with sensitive antibiotic (levofloxacin, i.v. infusion) and bladder wash-out method in 1/5000 furacin..
