Page 1 of 1: MCQ-solve this

sea_corel · Credits: 11961 My Scrapbook My Reading List 7 Books

A 25-year-old female presented with 1 year history of fever, pain with swelling in lower back, anorexia and weight loss. Physical examination revealed mild pallor and a fluctuant, non-tender paraspinal swelling in dorsolumbar region. There was no icterus, hepatomegaly or neurological deficit. Examination of other systems was non-contributory.

Relevant investigations were as follows:

Hemoglobin: 9.6 gm %
TLC: 4,700/cu mm
ESR: 55mm in 1st hour
SGPT: 32 IU/L
SGOT: 28 IU/L
Serum bilirubin: 0.8 mg%
Serum alkaline phosphatase: 118 IU/L
Mantoux text: 18x20 mm (5TU)
ELISA for HIV: -ve
Normal kidney function tests, urine analysis and chest skiagram. X-ray of dorso-lumbar spine depicted erosion of left transverse process of 12th thoracic and first lumbar vertebrae, and a soft tissue shadow in relation to the same region.
Ultrasonography of the abdomen done to delineate the extent of the paravertebral soft tissue shadow incidentally also showed a subcapsular abscess measuring 5.5x4 cm in the right lobe of the liver, which was further confirmed on CT scan of abdomen.
An ultrasound guided aspiration of both liver and paraspinal abscesses yielded thick pus, which was positive for AFB on staining, but negative for pyogenic organisms on culture.

whats the diagnisis????

sea_corel · Credits: 11961 My Scrapbook My Reading List 7 Books

m not able to uplosd the CT image it says not a valid image..what could be the prob???

sea_corel · Credits: 11961 My Scrapbook My Reading List 7 Books

RXPG team plz help......

sd04 · Credits: 4237 My Scrapbook My Reading List 9 Books

well c/p n radiographs suggestive of pott's disease,confirmed by +ve AFB in pus

wat do u say???

sea_corel · Credits: 11961 My Scrapbook My Reading List 7 Books

right....on the target...

tell me its management....

sd04 · Credits: 4237 My Scrapbook My Reading List 9 Books

well ttt is with prolonged systemic chemotherapy, using a combination of isoniazid and rifampicin,& may be necessary to surgically evacuate necrotic bone and pus if progressive deformity and destruction occurs.

As a rule The treatment of tuberculosis is in two phases.

The initial phase lasts 8 weeks and uses 3, or 4 if resistance is thought to be a problem, antibacterial agents concomitantly. Treatment of choice is:

* isoniazid
* rifampicin
* pyrazinamide
* plus or minus, ethambutol or streptomycin

The continuation phase. After the initial phase treatment is continued with isoniazid and rifampicin for 4 months. Ethambutol can be used with either isoniazid or rifampicin but requires a longer course.

We can consider Rifampicin, isoniazid, ethambutol and pyrazinamide in preg as these are safe to use during pregnancy; however, streptomycin should be avoided.

N.B rifampicin reduces the effectiveness of the combined oral contraceptive pill; it also halves the pharmacological effect of concurrent progesterone.
for dosages u can see in any txtbook!
wat do u say??

sea_corel · Credits: 11961 My Scrapbook My Reading List 7 Books

what bout the outcome or prognosis?? completely curable or not??

sd04 · Credits: 4237 My Scrapbook My Reading List 9 Books

well i guess complication is potts paraplegia due to compression so ttt in rt time n for proper period we can atleast save the spinal cord compression n prognosis varies

dsp · Credits: 1962 My Scrapbook My Reading List 23 Books

The diagnosis is of course, Tubercular abscess. But the real Question is where has it come from? Has it come from the Liver? In that case, does the patient have disseminated TB?

In this particular case, There are a few pointers AGAINST TB Spine
1. Bone TB is Paucibacillary - The pt has AFB + in pus -> does not fit
2. It is uncommon for tuberculous paraspinal abscess to go into the liver - Usually, they track along the psoas muscles
3. IsolatedTb of the transverse of the spine is not common - Bone erosions may be secondary to the abscess.

At this level, (T12 L1)other sources need to be looked at (Did the CT cover those?)
a. Kidney
b. Adrenal
c. Lymph Nodes

Does the CT scan show any vertebral involvement?

AN MRI Scan is the investigation of choice - It will reliably tell us whether a spinal focus exists or not.

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