SALIENT FEATURE Mr. Sharif, aged 40 Years, hailed from Mymensingh Jail, came to MMCH on 06-04-06...
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Transcript of SALIENT FEATURE Mr. Sharif, aged 40 Years, hailed from Mymensingh Jail, came to MMCH on 06-04-06...
SALIENT FEATURESALIENT FEATURE
Mr. Sharif, aged 40 Years, hailed from Mr. Sharif, aged 40 Years, hailed from
Mymensingh Jail, came to MMCH on 06-04-06 Mymensingh Jail, came to MMCH on 06-04-06
with the complaints of: with the complaints of:
1. 1. One rough surfaced elevation of skin in the One rough surfaced elevation of skin in the
left axilla for 3 left axilla for 3 ½ years and another same ½ years and another same
type of elevation of skin on the right foot type of elevation of skin on the right foot
for 2½ years.for 2½ years.
2.2. Numerous small elevations of skin over Numerous small elevations of skin over
the the back and right side of the trunk for back and right side of the trunk for
4 4 months. months.
3.3. Mild cough for 6 months.Mild cough for 6 months.
On Examination – The lesion in the left On Examination – The lesion in the left
axilla reveals warty, fissured, rough, plaque axilla reveals warty, fissured, rough, plaque
type type
lesionlesion extending from anterior axillary extending from anterior axillary
fold in an irregular and linear fashion up fold in an irregular and linear fashion up
to the posterior axillary fold.to the posterior axillary fold. The apical The apical
axillary lymph node is palpable and non axillary lymph node is palpable and non
tender. The lesion in the right foot is also tender. The lesion in the right foot is also
warty, fissured, rough, plaque type with warty, fissured, rough, plaque type with
mildmild
oozing, and is circumscribed. 3 of oozing, and is circumscribed. 3 of
inguinal lymph nodes of right side are inguinal lymph nodes of right side are
palpable and palpable and
non-tender, discrete. The lesions on non-tender, discrete. The lesions on
the back & right side of the trunk are the back & right side of the trunk are
papular, some with central necrosis papular, some with central necrosis
with features of few scar and eruption with features of few scar and eruption
of new lesions. All lesions mentioned of new lesions. All lesions mentioned
are painless, non-tender and non-itchy. are painless, non-tender and non-itchy.
His cough is mild & semi Productive. His cough is mild & semi Productive.
The patient is developing anorexia, The patient is developing anorexia,
weakness and undergoing gradual loss weakness and undergoing gradual loss
of weight of weight
but no evening rise of temp. or no night but no evening rise of temp. or no night
sweating or no H/O haemoptysis. He is also sweating or no H/O haemoptysis. He is also
mildly anaemic. He was treated with mildly anaemic. He was treated with
medicines like cephalosporines, flucloxacillin medicines like cephalosporines, flucloxacillin
and fluconazole.and fluconazole.
INVESTIGATIONINVESTIGATION
POSITIVE FINDINGS:
1. ESR : 50 mm in first hour.
2. Hb : 60%
3. M.T : 20mm in 72 hours.
4. X-ray : Chest P/view: Specific infection in right upper lung.
5. Skin biopsy for histopathology:
Dx : Tubercolosis verrucosa cutis (TVC).
OTHER FINDINGSOTHER FINDINGS
1.1. Sputum for AFB : NegativeSputum for AFB : Negative (3 consecutive (3 consecutive
days).days).
2.2. T.C. of WBC T.C. of WBC : : 9000/cumm.9000/cumm.
D.C. of WBCD.C. of WBC --
Neutrophil Neutrophil - - 60%.60%.
Lymphocyte Lymphocyte - - 36%.36%.
EosinophilEosinophil - - 02%.02%.
MonocyteMonocyte - - 02%.02%.
OTHER FINDINGS( Contd,)
3. Skin scraping for fungus:
M/E : No fungul elements found.
Culture: Growth of M.canis.
4. RBS : 88mg/dl.
DIAGNOSIS: DIAGNOSIS: Tuberculosis Tuberculosis verrucosa cutis verrucosa cutis with pulmonary with pulmonary tuberculosis with tuberculosis with papulo-necrotic papulo-necrotic tuberculid. tuberculid.
TREATMENTTREATMENT
Antitubercular drugs : Category - III Antitubercular drugs : Category - III