Dear Madam,

Thank you for posting your query on XXXXXXX

Well looking into your history i see that there is persisting painful swelling in your armpit which has not subsided after a course of antibiotics which is a serious issue and needs evaluation.

There can be multiple causes for this specially the infections namely tuberculosis , bacterial , some malignancies like breast cancer and other systemic diseases.

It will be difficult for me to comment about the cause just on history . I suggest you to see a physician who will examine the size , number , tenderness , consistency etc. , plan for investigations like CBC , ESR , Mantoux test , FNAC of lymph node , Biopsy of lymph node if required .

Only after the diagnosis of cause treatment would be initiated.

Take care.

Get well soon.

Dr. Shruti

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Dear Madam ,

Still in our country the possibility of tuberculosis is very high and it needs to be ruled out as first cause.

If your CBC and ESR are normal, the FNAC of lymph node is the best next option to make a diagnosis as the condition is not responding to antibiotics .

Hope this suffices.

Dr. Shruti

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Dear Madam,

Thanks for getting back.

Your doctor has prescribed you another course of antibiotics. These are different class of antibiotics than what you have taken earlier . May be he thinks it is just a bacterial infection that has not responded to earlier antibiotics . He remains the best judge because he has examined the lymph nodes.

But still you can go for a second opinion if you wish or else continue with the course he has advised .

Take care.

Dr Shruti

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Dear Madam,

Thanks for getting back.

Your doctor has prescribed you yet another course of antibiotics. . May be he is still thinking on lines of bacterial infection . FNAC is suggestive of infective pathology . You can take these medicines .

Now I cant say conclusively since all your reports are normal . Please get yourself examined for any breast mass as they can also lead to axillary lymph node enlargement. Biopsy will be the last option but i dont think it is required if your treating doctor does not feel so .

Take care.

Dr Shruti

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Dear madam,

Thanks for getting back .

Ankle swelling and pain is not much known side effect of levofloxacin . Arthralgia, myalgia, skeletal pain, tendinitis are uncommon side effects (0.1% to 1%). If you think the swelling has got a strong correlation with intake of levofloxacin , see your treating doctor and ask for a change of this drug .

Take care.

Dr. Shruti

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Dear madam,

Thanks for getting back .

This is something unusual .It is less likely to be caused by NBTM but whenever found is generally caused by MAC, Medical therapy for NTMB involves multiple agents for clearance of organisms and minimizing drug resistance. The cornerstone agents include macrolides, ethambutol, and rifamycin. Macrolides are the most effective agents against NTMB. But the treatment needs to be indivisualised . I advise you to get yourself tested for HIV , HbsAg , HCV to rule out any immunosupressed state also .

Kindly XXXXXXX a pulmonologist for further advise.

Take care.

Dr. Shruti

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