medical quiz
TRANSCRIPT
COS Quiz 6
August 2014
Case history
• 59 yr old male
• Low back ache
• Radicular pain for quite some time
Roentgenogram
MRI
MRI
• Underwent minimally invasive discectomy at one center…L4-5 and L5-S1
• 5 days later he was complaining of pain again
Rpt MRI
• Thought of infection • Send to another centre• There he was re explored • Found nothing • Gave antibiotics , antidepressants analgesics• HPE—acute on chronic inflamation• His pain persisted • ESR – 90 mm/hr• TC, DC –Nl• Gradually he developed inability to walk , severe
pain at night, leg cramps, weakness of both lower limbs
• Taken to another centre– but the same treatment
Follow up MRI
ESR -120mm/hr
X-ray– at 8 months
ESR reduced to 90 mm/hr
Present MRI
• Biopsy from a fresh site taken at this time
• HPE—acute on chronic infection
Diagnosis ?
• 1.M. Tuberculosis infection
• 2.Disseminated malignancy
• 3.Fungal osteomyelitis
• 4. Brucellosis
• 5.Ochronosis
• 6.None of the above