Rationale: Infections with Sphingomonas paucimobilis are rarely described in the literature and can be community-acquired or associated with healthcare, especially in patients with chronic conditions (e.g., diabetes mellitus), malignancies, or other causes of immunosuppression, except in people without comorbidities. We present the case of a patient with diabetes mellitus and hypertension diagnosed during a routine evaluation, with splenic abscess caused by S paucimobilis . Our literature search revealed no other case report of splenic abscess caused only by S paucimobilis . Patient concerns: We present the case of a 55-year-old Caucasian man with type 2 diabetes mellitus and hypertension. Diagnosis: Thoraco-abdominal computed tomography revealed splenomegaly of 20X16X18 cm, with a homogeneous subcapsular hypodense collection, with a mass effect on the left hemidiaphragm. Interventions: The patient underwent surgical intervention and S paucimobilis was isolated on blood agar. Outcome: The patient received treatment with ciprofloxacin (500 mg twice daily) for 14 days, with favorable outcomes. Lessons: S paucimobilis , a low-virulence bacterium, can cause community-acquired or nosocomial infections. Visceral localizations, usually symptomatic, can evolve rapidly, and the diagnosis is associated with complications or, as in our case, with careful investigation of some changes in laboratory investigations.

Rationale:Primary hyperparathyroidism, usually as a result of a hyperfunctioning parathyroid gland, represents more than 90% cases of patients evaluated for hypercalcemia. Combined techniques of preoperative scintigraphy and SPECT/CT serve as a successful minimally-invasive parathyroidectomy. This recent imaging method provides four-dimensional functional images with advanced contrast resolution which greatly facilitates preoperative localization of parathyroid adenomas.Patient concerns:We presented the case of a male Caucasian patient, aged 67 years, who was investigated for hypercalcemia. Increased levels of parathormone, cervical ultrasonography without pathological changes, and negative planar parathyroid scintigraphy have led to the performance of a parathyroid scintigraphy combined with SPECT/CT.Diagnoses:The diagnosis of right inferior parathyroid adenoma was confirmed by the 99mTc-MIBI-SPECT/CT that revealed on early phase increased radiotracer uptake in the area of projection of the lower third of the right thyroid lobe. The SPECT/CT scan localized this area behind the lower pole of the right thyroid lobe, in the right side of the trachea, with CT correspondent of hypodense lesion, with a maximum diameter of 20 mm.Interventions:During hospitalization, the decision to undergo surgical intervention was taken. The patient underwent surgical intervention, and minimally-invasive right inferior parathyroidectomy was performed.Outcomes:The histopathological examination confirmed the diagnosis and the patient's recovery was complete, with the normalization of parathormone, calcium levels, and metabolic parameters.Lessons:Modern combined techniques of scintigraphy and SPECT/CT proved to be of excellent clinical utility in the preoperative diagnosis of primary hyperparathyroidism, localizing a parathyroid tumor undetected by planar scintigraphy alone.

Introduction. Endocrino-metabolic rehabilitation represent one of the most complex sector in clinical medicine, regarding functional rehabilitation. Sex hormones deficiency plays an important role in the etiology of osteoporosis in men. At the same time, with age, the trophic role of androgens on muscle decreases and determines an increased frequency of falls. The objective of our study is to determine the association between sexsteroids deficiency, reduction of bone mineral density (BMD) and falling risk in men. Methods. Our retrospective cross-sectional study included 146 men aged between 65–85 years with low BMD (study group) and 121 men with normal BMD (control group). The measurement of Total testosterone (Tt), free testosterone (Tf) and estradiol (E2) serum levels was performed using the immunoassay or the immunoenzymatic methods. Femoral neck and lumbar spine BMD was determined using Dual-energy X-ray absorptiometry (DEXA). The risk of falls was assessed by Tandem Standing, Up & Go, Chair – Rising and walking speed tests. Results. We found a significantly association between Tf and E2 deficiency and low BMD (p=0.007). Also, in men with reduced BMD (study group) we observed significant lower levels of Tf (p<0.001) and E2 (p=0.003) compared to control group. E2 deficiency was associated significantly with low BMD and increased fall risk (p=0.001). At the same time the results highlighted significant lower levels of Tf in patients with BMD reduction and increased risk of falls (p=0.002). Tt deficiency was not associated with BMD reduction (p=0.088) or increased risk of falling (p=0.277). Conclusions. This research revealed a significant association between male sexsteroids deficiency, low BMD and increase of falling risk, with implications in rehabilitation program. The risk of ostoporosis and for falling in man can be estimated by determining serum Tf and E2 levels. Keywords: sexsteroids deficiency; bone mineral density; falling risk,

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