A 60-year-old man presented with a 3-month history of nonhealing ulcer over the tip of his right thumb. The ulcer started as a blister over the tip of the thumb that later ruptured and spread proximally to cover the whole pulp area of the thumb. There was no history of trauma, fever, weight loss, or loss of appetite. He is a pensioner and an avid gardener. He has a few cats as pets. The patient initially presented to a private orthopedic surgeon with a nonhealing ulcer of the right thumb. Multiple debridements were unsuccessful in ameliorating the ulcer. Three months after the onset of the initial lesion, multiple painless erythematous nodules had developed on his right arm, and one on the right thigh. All routine blood investigations were nondiagnostic. Swab culture from the ulcer failed to grow any organism and a course of antibiotics did not resolve the problem. Cultures of the biopsy specimen using Sabouraud's dextrose agar and potato carrot medium grew dark brown plaques that microscopically appeared to be branching hyphae. A diagnosis of sporotrichosis of the right upper limb was made and the patient was started on antifungal treatment immediately (T. Itraconazole [Sporanox] 200 mg BD). One month after commencement of antifungal treatment, the ulcer began to dry up and at 3 months all the lesions including the one on the right thigh had healed.
Juxtafacet cyst of the spine is a rare occurrence. Reports have described them as synovial cysts; ganglion cysts; extradural cysts as well as degenerative cysts of the spine. Patients may present with radicular pain, motor deficits, sensory disturbances, cauda equina syndrome and even myelopathy. Lumbar juxtafacet cysts may be confused clinically with prolapsed intervertebral discs or other conditions involving nerve root compression such as arachnoid cysts, ependymal cysts, dermoid cysts or teratomatous cysts. In the case of the juxtafacet cyst, surgical excision is usually curative. We report a case of spinal synovial juxtafacet cyst found intraoperatively in a case that was preoperatively diagnosed as prolapsed intervertebral disc. Synovial juxtafacet cyst of the spine should be considered as one of the differential diagnoses in patients, especially in older patients, presenting with nerve root compression.
Arthroscopic posterior cruciate ligament (PCL) reconstruction carries some risk of complications, including injury to the neurovascular structures at the popliteal region. We describe a delayed presentation of the right leg and foot compartment syndrome following rupture of popliteal artery pseudoaneurysm, which presented 9 days after an arthroscopic transtibial PCL reconstructive surgery. Fasciotomy, surgical exploration, repair of an injured popliteal vein and revascularisation of the popliteal artery with autogenous great saphenous vein interposition graft were performed. Owing to the close proximity of vessels to the tibial tunnel, special care should be taken in patients who undergo arthroscopic PCL reconstruction, especially if there is extensive scarring of the posterior capsule following previous injury. Emergency fasciotomy should not be delayed and is justified when the diagnosis of compartment syndrome is clinically made.