Patient : 28 yrs old Female
Diagnosis of MRI done on 2nd Apr 10 : MR imaging of Left knee joint reveals a large irregular lobulated thick walled lesion showing central fluid intensity noted in the metaepiphyseal region of the lower femur causing mild thinning of the anterior cortex and small defect in the posterior cortex with extension into the adjacent soft tissue posterior to the femur. Note also made of edema and fat stranding in the soft tissue surrounding the lesion as well as lower metaphyseal region of femur. Findings suggest Differential of infective etiology with the remote possibility of mitotic lesion. As compared to previous MRI dated 27th Oct 09, Perilesional marrow edema and joint effusion appears to have reduced while the collection/extension in the posterior soft tissue appears to have increased.
CORE BIOPSY done on 30th Oct 09 (after MRI dt. 27th Oct 09) - Histo Biopsy Small - Specimen Type - Caseous material from lower end femur. Clinical Data/Impression - Pain left knww with lytic areas. Opinion - Subacute Nectrotizing inflammation.
Test (AURO-TB-PCR-1): Sample - PUS from Lession. Result : Positive. The given sample contains Mycobacterium Tuberculosis.
After the above findings of Biopsy, the line of treatment given is AKT4 (for 2 months) changed to AKT3 (3months). Total Treatment duration till date is 5 months.
Kindly look into the same and suggest the most likely diagnosis and also the kind of treatment required o be given.