scholarly journals The Spine Crasher: A Challenging Diagnosis

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Muhamad Azamin Anuar ◽  
Mossad Abdelhak Shaban Mohamed ◽  
Nur Syuhada Mohd Azhar ◽  
Asrar Abu Bakar ◽  
Taufiq Hidayat Hasan
Keyword(s):  
Pulmonary Tuberculosis ◽  
Inflammatory Markers ◽  
Spinal Tuberculosis ◽  
Bone Destruction ◽  
Lower Limbs ◽  
Mantoux Test ◽  
Low Grade ◽  
Radiological Investigation ◽  
Gross Motor ◽  
History Of

Introduction: Spinal tuberculosis in children is an established preventable disease in developing countries. Complications are devastating due to its aptitude to cause bone destruction, spinal deformity and paraplegia. Case report: We present an eight-month old girl with isolated gross motor regression and evolving spastic paraplegia. It highlights the challenge we encountered due to delay in garnering the pertinent investigation. She presented to clinic with history of legs weakness and loss of rolling after a period of prolonged febrile illness. Both parents are medical practitioners. Mother had history of SVT during pregnancy in spite on anti-arrhythmic treatments. Her father is a thalassaemia carrier. A thorough examination revealed gross motor delay and upper motor neuron signs. She had raised inflammatory markers, anaemia and thrombocytosis with persistent low-grade temperature. CT brain with contrast showed meningeal enhancement. Full septic work up revealed the CSF result reflecting partially treated meningitis. She was treated with third generation cephalosporin and acyclovir. Mother claimed exposure to TB patients hence Mantoux test was recommended which came positive. Her chest x-ray, sputum culture, CSF culture and NAA studies came non-conclusive for pulmonary tuberculosis. MRI for brain and spine showed features of tuberculous spondylodiscitis of T4-T5 vertebrae with associated subligamentous paravertebral spread and epidural extension causing spinal cord compression and T3-T6 hydro-syringomyelia. After multidisciplinary team discussion, patient started on intensive antituberculosis regimen with good initial response. Discussion: Clinically lower limbs power improved with good antigravity movement. Laboratory and radiological investigations have improved inflammatory markers and dropping trend thrombocytosis, and spinal gibbous stay stationary with improvement in plain radiology. She is under regular follow up awaiting serial MRI. Conclusion: The challenge in diagnosis of extra pulmonary tuberculosis in infants is getting them excluded early. High index of suspicion along with radiological investigation is vital to aid the diagnosis and establishment of treatment to expect a good outcome.

scholarly journals P045 Nothing is too 'cagey' for the rheumatologist

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Muhammad F Kazmi
Keyword(s):  
Weight Loss ◽  
Inflammatory Markers ◽  
Low Grade ◽  
Careful Monitoring ◽  
Chronic Infections ◽  
Asian Origin ◽  
Travel History ◽  
Chest Clinic ◽  
History Of ◽  
Inflammatory Changes

Abstract Background/Aims  Rheumatological conditions can present with a number of non-specific features like arthralgia, fever, fatigue, weight loss along with raised inflammatory markers and positive antibodies. Due to this, when similar symptoms are referred for input it is very important to consider other ‘mimics’. We report a case of Pigeon fancier’s lung presenting with these symptoms which was referred as likely connective tissue disease. Methods  A 52-year-old lady of South Asian origin was referred by her GP with six month history of 3kg weight loss, arthralgia, fatigue, low grade fever and persistently raised inflammatory markers (ESR ranging from 50-64 mm/hr, CRP 10-14 mg/L, normal BMI). On further questioning there was history of mouth ulcers, non-specific rash, occasional cough but no Raynaud’s or joint swelling. Blood investigations showed weakly positive ANA and RF but negative ENA, DNA, antiCCP , CK, C3,C4. C-ANCA was positive but PR3 negative. CXR was clear and tests for chronic infections including TB were negative. Due to lack of objective CTD signs, plan was to take a careful monitoring approach to see if clinical features evolved. A month later due to worsening cough, a CT chest/abdomen arranged by GP showed ground-glass changes consistent with pneumonitis and hence her rheumatology appointment was expedited to see if there was an autoimmune unifying diagnosis. She was also referred by her GP to the chest clinic in view of CT report and mild shortness of breath. Results  On further review, again there were no objective CTD signs. On direct questioning there was history of travelling before worsening chest symptoms to South Asia. Also around a year before her symptoms started she was given an African grey parrot. Based on this, serology for Avian precipitin was checked which showed strongly positive IgG antibodies to avian antigens (Budgerigar droppings and feathers, Pigeon feathers IgG Abs) confirming the diagnosis of pigeon fanciers lung. She fulfilled the diagnostic criteria and was asked to avoid the trigger. Urgent respiratory input was arranged where diagnosis was agreed with and disease was deemed sub-acute in presentation. Due to PFTs showing low transfer factor of 38%, Prednisolone was started with significant improvement within few days. Review of CT chest only showed inflammatory changes and no established fibrosis predicting excellent prognosis as delay in treatment can cause irreversible pulmonary fibrosis. Conclusion  A number of conditions can mimic rheumatological conditions which usually turn out to be either infectious or malignant in origin. This case highlights the importance of considering other differentials and along with taking a travel history also asking for other possible triggers like pets. In similar scenarios the diagnosis may be ‘cagey’ but as rheumatologists we are expected to answers questions which others can’t. Disclosure  M.F. Kazmi: None.

scholarly journals The Challenge of Skin Lesions in Systemic Diseases

2021 ◽  
Author(s):  
Ana Isabel Lopes ◽  
Isabel O. Cruz ◽  
Rui Môço
Keyword(s):  
Erythema Nodosum ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Low Grade ◽  
Systemic Diseases ◽  
Medical Problems ◽  
Anterior Side ◽  
History Of ◽  
Nodular Lesions ◽  
Inflammatory Drugs

A 47-year-old man, obese, without medical problems, presented with a 15-day history of painful erythematous nodular lesions on the anterior side of lower limbs. He had no improvement with antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs). He developed migratory and symmetric arthralgias (ankles, knees, elbows) and low-grade fever. The skin lesions progressed to the upper limbs. On physical examination, a mild swelling and tenderness in both ankles was noted, and lesions suggestive of erythema nodosum were seen.[...]

scholarly journals Sacral Tuberculosis: An Atypical Manifestation

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Faisal Amir Si Mirah ◽  
Ahmad Faizal Roslan ◽  
Ed Simor Khan Mor Japar Khan ◽  
Rajandra Kumar Karupiah ◽  
Zamzuri Zakaria @ Mohamad
Keyword(s):  
Correct Diagnosis ◽  
Lower Limbs ◽  
Mantoux Test ◽  
Ct Guided ◽  
Walking Aids ◽  
Grade 5 ◽  
History Of ◽  
Prolapsed Intervertebral Disc ◽  
The Right ◽  
High Index Of Suspicion

Sacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Intervertebral Disc (PID), but showed no improvement despite regular physiotherapy and medication. Subsequently, the pain was confined to the right gluteal area and became more severe. Quality of life was impaired in which patient started using walking aids and stopped working. There was a weight loss of 20kg. No other symptom of TB infection or history of contact with TB patient. Bowel and urinary functions were normal. Examination showed localized tenderness at the right gluteal area. Neurological assessment of both lower limbs were MRC grade 5. Blood investigations were normal including the ESR level (17mm/hour). Mantoux test was positive with 18mm induration. MRI revealed a large rim enhancing paravertebral collection at pre-sacral space which extended into bilateral piriformis and gluteal muscles. The patient underwent CT-guided drainage of both gluteals and specimens taken to confirm the diagnosis of TB. Patient showed significant improvement clinically within 1 week after the drainage procedure and initiation of antituberculous chemotherapy. The initial presentation of this patient mimics PID due to irritation of sciatic nerve at piriformis level. However a change in the presentation and failure of conservative treatment should raise a high index of suspicion and necessitates further investigation to establish correct diagnosis hence proper treatment can be initiated.

A CASE OF SPINAL TUBERCULOSIS MISEVALUATED AS INTESTINAL OBSTRUCTION

2021 ◽  
pp. 32-33
Author(s):  
Chepuri Sagar
Keyword(s):  
Intestinal Obstruction ◽  
Spinal Tuberculosis ◽  
Low Grade ◽  
X Ray ◽  
Pott’S Disease ◽  
Pain Abdomen ◽  
Chief Complaints ◽  
History Of ◽  
Extra Pulmonary ◽  
Tuberculosis Of Spine

Tuberculosis of spine (Pott's disease) is a frequently encountered extra pulmonary form of tuberculosis and is the most dangerous form . We report a case of spinal tuberculosis which present with clinical features of intestinal obstruction. A 45 1 year old male patient came to general surgery out patient department with chief complaints of pain abdomen since two weeks, constipation since two weeks and distension of abdomen since 10 days. History of fever present since 2 months low grade on and off. Case was evaluated with X ray erect abdomen, colonoscopy, CT abdomen which showing features of tuberculosis of spine. Patients of tuberculosis of spine can be asymptomatic and sometimes diagnosis is made incidentally during the course of evaluation for other symptoms

scholarly journals Prevalence of pulmonary tuberculosis in young adult patients with Type 1 diabetes mellitus in India

2016 ◽  
Vol 11 ◽  
Author(s):  
Ravinder Goswami ◽  
Abilash Nair ◽  
Randeep Guleria ◽  
Devasenathipathy Kandasamy ◽  
Raju Sharma ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Pulmonary Tuberculosis ◽  
Type 1 Diabetes Mellitus ◽  
Sputum Culture ◽  
Mantoux Test ◽  
Care Hospital ◽  
History Of ◽  
Culture Positive

Background: There is limited information on prevalence of pulmonary tuberculosis (PTB) in patients with type-1- diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital. Methods: 151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M.tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist. Results: 5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M.tb by culture, giving a prevalence of 10.6 % sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M.tb culture positive and four asymptomatic patients with sputum culture positive for M.tb on two occasions (6 weeks apart) were put on antitubercular treatment (ATT). Patients who were culture positive for M.tb only on one occasion were kept on a close follow up. Conclusions: Patients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M.tb culture in order to initiate early treatment and to prevent transmission in the community.

Scurvy presenting as lower limb ecchymoses in the setting of metastatic colorectal cancer

2020 ◽  
Vol 13 (12) ◽  
pp. e237507
Author(s):  
Joshua M Inglis ◽  
Jia Tan
Keyword(s):  
Lower Limb ◽  
Inflammatory Markers ◽  
Pelvic Exenteration ◽  
Lower Limbs ◽  
Foot Drop ◽  
Sigmoid Colectomy ◽  
Metastatic Colon Cancer ◽  
Ankle Foot Orthosis ◽  
History Of ◽  
Foot Orthosis

A 58-year-old woman presented with a 1-week history of lower limb bruising. She had a medical history of recurrent metastatic colon cancer with a sigmoid colectomy and complete pelvic exenteration leading to colostomy and urostomy formation. She had malignant sacral mass encroaching on the spinal cord. This caused a left-sided foot drop for which she used an ankle-foot orthosis. She was on cetuximab and had received radiotherapy to the sacral mass 1 month ago. On examination, there were macular ecchymoses with petechiae on the lower limbs. There was sparing of areas that had been compressed by the ankle-foot orthosis. Bloods showed mild thrombocytopaenia and anaemia with markedly raised inflammatory markers. Coagulation studies consistent with inflammation rather than disseminated intravascular coagulation. She was found to have Klebsiella bacteraemia secondary to urinary source. Skin biopsy showed dermal haemorrhage without vessel inflammation. Vitamin C levels were low confirming the diagnosis of scurvy.

scholarly journals Idiopathic Spinal Cord Herniation—Case Report

2016 ◽  
Vol 37 (03) ◽  
pp. 280-283
Author(s):  
Rogerio Sacco ◽  
Ricardo Gepp ◽  
Marco Quiroga ◽  
Henrique Souza ◽  
Vitor Aguiar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Lower Limbs ◽  
Surgical Trauma ◽  
Dural Defect ◽  
Thoracic Myelopathy ◽  
Radiological Investigation ◽  
Postoperative Mri ◽  
Spinal Cord Herniation ◽  
History Of ◽  
Idiopathic Spinal Cord Herniation

AbstractIdiopathic spinal cord herniation is a rare cause of progressive myelopathy, especially in the absence of a history of spinal or surgical trauma. The radiological diagnosis is made through a myelography or an MRI exam. The spinal cord is pushed anteriorly, buffering the dural defect and leading in most cases to Brown-Séquard syndrome. The present study describes the case of a male patient with a clinical picture of progressive thoracic myelopathy. In the clinical and radiological investigation, an idiopathic spinal cord herniation on the chest level was identified. During the surgery, the spinal cord was reduced to the natural site, taking its usual elliptical shape, and the dural defect was repaired with a dural substitute. The numbness of the patient improved, and the shocks in the lower limbs disappeared. A postoperative MRI confirmed the surgical reduction of the herniation and the restoration of the anterior cerebrospinal fluid (CSF) column to the spinal cord. The authors describe the clinical, radiological, intraoperative, and postoperative evolution.

scholarly journals Tuberculosis of Sacrum: A Rare Location of Spinal Tuberculosis

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Patrice LWY Sinaga ◽  
Sabri ◽  
Ridha Dharmajaya
Keyword(s):  
Spinal Tuberculosis ◽  
Thoracolumbar Spine ◽  
Night Sweat ◽  
Low Grade ◽  
Low Back ◽  
Gluteus Muscle ◽  
The World ◽  
Rare Location ◽  
History Of ◽  
Anterior Posterior

Tuberculosis is one of the most common infectious diseases in the world. The thoracolumbar spine is the commonest form of vertebral tuberculosis, whereas isolated tuberculosis of the sacrum is rarely reported in the literature. A male patient of 22-year old had complained low back pain since 2 years before admission to hospital without history of trauma on back. He also got low-grade fever and weight loss. There was no tuberculosis contagion found, no cough or night sweat. Clinical examination revealed neurological deficit with strength of both lower extremities were 4 and hipestesia in the level of lumbal 5 and downward. Radiographs of lumbosacral showed deformity of lumbal 5. CT scans of spine showed deformity of sacrum. MRI revealed spondylolisthesis L5-S1, S1-S2, S2-S3 and mass in the anterior posterior and lateral of paralumbal 5 and parasacral. There is no involvement of gluteus muscle and the around muscle. The patient underwent surgical of sequestrectomy with drainage abscess and lumbo-sacral-illiac fusion. The culture of sacral tissue showed Mycobacterium tuberculosis. The patient was treated with combination of four antituberculosis agents.

scholarly journals Subcutaneous Emphysema without Pneumothorax or Pneumomediastinum in Pulmonary Tuberculosis

2012 ◽  
Vol 13 (2) ◽  
pp. 250-251
Author(s):  
Ahmad Mursel Anam ◽  
Farzana Shumy ◽  
AHM Waliur Rahman ◽  
Mohammad Ferdous Ur Rahaman ◽  
MA Jalil Chowdhury
Keyword(s):  
Weight Loss ◽  
Pulmonary Tuberculosis ◽  
Subcutaneous Emphysema ◽  
Rare Case ◽  
Mantoux Test ◽  
High Concentration ◽  
Oxygen Inhalation ◽  
History Of ◽  
Background History

We report a rare case of subcutaneous emphysema without pneumothorax or pneumomediastinum. A 20-year-old gentleman presented with swelling of face and neck, dysphagia and dyspnoea, with the background history of fever, dry cough and weight loss. On examination, there was feeling of crepitus all over the swollen areas, and crackles heard over both lung fields. He had high ESR, with positive Mantoux Test and sputum was positive for AFB. He was put on high concentration oxygen inhalation along with anti-tubercular chemotherapy. Following treatment he was clinically and radiologically improved, and was discharged with the advice to complete the anti-tubercular chemotherapy. DOI: http://dx.doi.org/10.3329/jom.v13i2.12773 J Medicine 2012; 13 : 250-251

Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 155-160
Author(s):  
Mohsen Aghapoor ◽  
◽  
Babak Alijani Alijani ◽  
Mahsa Pakseresht-Mogharab ◽  
◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
The Body ◽  
Lower Limbs ◽  
Lumbar Pain ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Death Case ◽  
Therapeutic Results ◽  
History Of ◽  
Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

Sign in / Sign up

Export Citation Format

Share Document