Download SALIENT FEATURES

SALIENT FEATURE
Mr. Sharif, aged 40 Years, hailed
from
Mymensingh Jail, came to MMCH on 06-04-06
with the complaints of:
1.
One rough surfaced elevation of skin in the
left axilla for 3 ½ years and another same
type of elevation of skin on the right foot
for 2½ years.
2.
3.
Numerous small elevations of skin over
the
back and right side of the trunk for
4
months.
Mild cough for 6 months.
On Examination – The lesion in the left
axilla reveals warty, fissured, rough, plaque
type
lesion extending from anterior axillary fold in
an irregular and linear fashion up to the
posterior axillary fold. The apical axillary lymph
node is palpable and non tender. The lesion in
the right foot is also warty, fissured, rough,
plaque
type
with
mild
oozing, and is circumscribed. 3 of inguinal
lymph nodes of right side are palpable and
non-tender, discrete. The lesions on the
back & right side of the trunk are papular,
some with central necrosis with features of
few scar and eruption of new lesions. All
lesions mentioned are painless, non-tender
and non-itchy. His cough is mild & semi
Productive.
The
patient
is
developing
anorexia, weakness and undergoing gradual
loss of weight
but no evening rise of temp. or no night
sweating or no H/O haemoptysis. He is also
mildly
anaemic. He was treated with
medicines like cephalosporines, flucloxacillin
and fluconazole.
INVESTIGATION
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 FINDINGS
1. Sputum for AFB : Negative
(3 consecutive days).
2. T.C. of WBC
:
9000/cumm.
D.C. of WBC
-
Neutrophil
-
60%.
Lymphocyte
-
36%.
Eosinophil
-
02%.
Monocyte
-
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: Tuberculosis
verrucosa cutis
with
pulmonary
tuberculosis with
papulo-necrotic
tuberculid.
TREATMENT
Antitubercular drugs : Category - III