IS IT MULTIFOCAL BONE TB_?

 
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A 4 years old boy presented with jaundice, ascitis, hepatomegaly and multiple abscesses over sternum and back for which he was on antituberculous therapy {ATT} for past 1 month. He was treated for tuberculosis {TB} at 1 year of age for 5 months in view of fever. At 2½ years of age, he had multiple abscesses over neck, sternum, back, left thumb. At 3 years, sternum abscess was drained and he was again given ATT for 7 months. At 3½ years of age, he had icterus and ascitis. There is no contact with a patient suffering from TB. On examination, height was 82 cm, weight was 13 kg and he had pallor, clubbing, a draining sinus over cervical region and sternum with hepatosplenomegaly and ascitis. On respiratory system, he had bilateral crepts. Other systems were normal. His CT chest showed osteolytic lesion in sternum with pericardial effusion, consolidation in left lower lobe of lung and right paravertebral abscess. Ascitic fluid did not grow any MTB after 6 weeks nor did the sternal pus. He was put on category 2 of ATT.
Expert Opinion :
This child was continued on same ATT in view of no growth on TB culture. However the other differential diagnosis that could be considered in this child would be CRMO {chronic recurrent multifocal osteomyelitis}.
Answer Discussion :
S
Shivramcash
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hyper IgE {Job} syndrome
5 years ago
S
Shivramcash
bubble
hyper IgE {Job} syndrome
5 years ago

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