Chronic osteomyelitis

Case

• ชื่อ Mrs.Anab Mohamoud Adan• อ.เบญ็จส์ชวี ์(เจา้ของไข้ )• ภมูลิำาเนา : โซมาเลีย• เบอรโ์ทรศัพท์ : 086-0104117• Dx. Chronic osteomyelitis

• CC : แผลเรื้อรงัท่ีขาซา้ย 4 ปี

• PE : multiple discrete ulcerated nodules on sclerotic plaque on left leg

Tissue Biopsy ( 19/02/2557)• Histopathology

- Proliferation of newly-formed blood vessels within myxoid stroma and mixed chronic and acute inflammatory cell infiltration including histiocytes and multinucleated giant cells.

- No granulomatous formation is indentified.- No epidermal component is seen.- No malignant feature is evident.

• AFB: negative• Tissue C/S for mycobacteria and fungus :no growth

Tissue biopsy (27/01/2558)• Histopathology

- Proliferation of newly-formed blood vessels within myxoid stroma and mixed chronic and acute inflammatory cell infiltration including histiocytes and multinucleated giant cells.

- No granulomatous formation is indentified.- No epidermal component is seen.- No malignant feature is evident.

• AFB : negative• Modified AFB : negative

Tissue biopsy (27/01/2558)• Tissue C/S for mycobacteria and fungus :no growth• PCR for mycobacterium tuberculosis complex :

negative

Histologic Diagnosis

Granulation tissue (may present in the tissue of chronic infection)

FNA (19/03/2558) • AFB stain : negative• Modified AFB stain : negative• C/S for aerobic and anaerobic bacteria : no growth• C/S for mycobacterial and fungus : no growth

X-ray (03/02/2558) • CXR : no abnormal finding• Both feet : fusion intertarsal and tarsometatarsal

bones, tibiatarsal interphalangeal with sclerotic flexion deformity at left 1st PCP

• Left leg : sclerotic change with multiple lucent entire left tibia with thick periosteal reaction, chronic osteomyelitis is likely

Lab• LFT, BUN, Cr , Blood sugar : normal• CBC : wbc 6,400 (N 73%, L 20%) Hb 12.2, Hct 35.5 MCV

86• Tuberculin skin test (17/03/2558) : negative• Anti HIV : negative• RPR : non-reactive TPHA : negative• HbsAg :negative HbsAb : negative• HBcAb : negative HCVAb: negative• FANA : positive 1:80 (speckled pattern)

Final diagnosis chronic osteomyelitis

Current Rx • รพ.ราชวถีิ repeat x-ray bone และ plan ทำา bone

biopsy• Plan repeat FNA & c/s skin lesion อีกรอบแต่ผู้

ป่วยติดปัญหา financial problem รอจดัการเรื่องค่าใชจ้า่ย