Diagnosed With Disseminated TB. Having Severe Pain From Left Upper Leg Through Down. Have Spasmodic Cramps During Pain. Suggest?

Posted on Mon, 28 Oct 2013

Question: I have 20 years old nephew who is diagnosed with Disseminated TB (starting with Pelvis region with inflamed lymph nodes near chest and lever).

Three months back, he started feeling severe pain from left upper leg through down. Two months back, MRI suggested Bone TB and he has been on ATT for the last two months. While he started showing some improvement during first one month. However, his fever is still persisting (now it goes upto 104 F in the night). While he is getting some relief on the left side, he is getting severe pain in the right leg. He also has spasmodic cramps during pain/fever. These things are worse during night when he has higher fever.

ATT is not responding effectively and he still has severe pain, fever and coughing. Another MRI was done 3 days back but situation is further worsen. Bone Marrow Biopsy has ruled out Lymphoma.

Now, Dr has advised a FNAC / Bone Biopsy so that the exact reason could be known. His today's TLC is around 28K, Uric Acid 11.2, Homeoglobin 11, ESR ~60, TSH (under 4).

Pls advise. Whether he will have disseminated TB but medicines are not effective or he will something else e.g. Osteomyelitis.

Answered by Dr. Rahul D Chaudhari (1 hour later)

Brief Answer:
Tissue diagnosis must and rule out MDR TB

Detailed Answer:
I understand your concern. First tissue biopsy is must. Get the sample and send it for TB testing histopath and get the culture sensitivity. Another important aspect is to rule out Multi drug resistant TB.
Whats the reason for such disseminated TB? unless you have low immunity or problem with immunity cells, unlikely to develop such TB. Any other significant medical history? Also if he has huge abscess which may need to be drained. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rahul D Chaudhari (24 hours later)

Thanks for your reply.

We have done today the FNAC and the report would be available on Monday. The doctor took the sample from the area near neck. Hope this was ok.

No reports indicated any abscess however CT scan / MRI etc. showed indicated lesions / necrosis and swollen lymph nodes.

Doctor has also prescribed below medicines. He thinks (98%) as TB.

R-CINX 600, Levoflox 750, Cobadex forte, Gemcal Cap, Ciplactin. For severe pain, high fever and cough, Zinase TP Tab. We have to still start these medicines.

So far, he has been taking R-CIX 600, P-zide (750x2), Combutol (600+300) alongwith Benadon (1/2). For fever, he is taking Calpol and for pain, he is taking Utraset or Voveron.

Hope the above changes in the medicines are ok.

Let me summarise once again, he is still having fever (high during nigh), cough (high during night) and pain (severe during night). Pain is felt more in the right leg (upper side near pelvis joint). He also vomits when he take medicine (particularly, before break fast).

Pls let us know what could be reason for such pain/fever/ cough.

What could be the other disease.

Thanks

Answered by Dr. Rahul D Chaudhari (11 hours later)

Brief Answer:
patient needs to be admitted

Detailed Answer:
I would consider admitting patient in the hospital. Is it a case of open kochs? is he having chest TB as well? I would advise start the treatment aggressively. If he is vomiting out the tablets then same medicine can be given in powder form along with intravenous medicine to stop vomiting. Start inj amikacin in addition to above treatment. daily blood count ESR CRP monitoring important. I would advise to take him to chest physician and get him admitted. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rahul D Chaudhari (5 hours later)

I have uploaded the fnac report which is very shocking and disturbing. Pls reveiw the same and provide your vaueable inputs urgently. What should be the next step.

For the last 2 months, he has been treated for tb and the new finding would be very challenging for us.

We got bone marrow biopsy done on 27th sep which came negative for lymphoma.

Pls urgently suggest.

Answered by Dr. Rahul D Chaudhari (12 minutes later)

Brief Answer:
sorry to hear the report

Detailed Answer:
I understand the situation. Get the excisional biopsy of the lymph node. Get the patient to cancer centre. Where are you located? do not go to local hospitals. He needs to be examined by oncologist and oncosurgeon. We have all facilities in pune. If you wish you can come here or go to near by metro city. Another option is TATA cancer institute Mumbai. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rahul D Chaudhari (2 hours later)

We live in delhi. Which hospital do you suggest which should have best treatment. Any doctor name with contact nos.

What would be the duration of complete treatment. Whether patient will require to stay in hospital during treatment.

What would be appox cost involved.

Any other info we should know.

Thanks

Answered by Dr. Rahul D Chaudhari (5 hours later)

Brief Answer:
Difficult to tell you about this

Detailed Answer:
I am not much aware about delhi. Again the treatment duration, hospitalisation and cost depends upon the stage of the lymphoma. Difficult to comment on it at this stage. Thanks.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar