2. Chief complaints:
• 51/ male, farmer, resident of Jalgaon, Maharashtra came with
complaints of;
1. Mid back pain with right girdle pain since 3 weeks
2. Weakness in both lower limbs since 2 weeks
3. HOPI:
• Patient was apparently alright 3 months back when he started c/o mid back pain
with left girdle pain and acute onset complete loss of bilateral lower limb power.
• For which he was hospitalized and underwent spine surgery at thoracic level and
was started on AKT
• After 1 month of AKT patient had h/o fever, anorexia, halitosis, generalized
weakness for which he had consulted local physician who had modified AKT
drugs
• Over a period of 2 months post surgery patient showed clinical recovery in the
form of decrease mid back and girdle pain and gradual improvement in b/l lower
limb power and started walking with support.
4. HOPI:
• Post 2 months of surgery,
-patient started c/o mid back pain which was insidious in onset,
gradually progressive and dull aching in nature. Aggravated with sitting,
standing, walking and relieved on lying supine. Its was associated with
right girdle radiation which was sharp shooting type and intermittent
initially which progressed to continuous pain.
5. HOPI:
• Post 2.5 months of surgery,
-patient started developing weakness in right f/b left lower limb.
Insidious in onset and acutely progressed from proximal to distal lower limb
which made him non walker since a week.
At present,
-patient is unable to stand and walk
-unable to log roll or sit in bed independently
-using bed pan and diaper for urination and defecation
6. • There is h/o change in AKT treatment by local physician
• h/o evening onset fever, anorexia, generalized weakness, halitosis
• h/o constipation and urinary hesitancy and incomplete voiding
• No h/o
-trauma/fall
-discontinuation/ missed AKT treatment
-visual or hearing issues
• No h/o
-Headache, convulsions
-Cough, expectoration
-abdominal/flank pain, blood or pus in urine
• No h/o
-post operative blood transfusion
-any long term medications other than AKT
8. • Past history : no other medical co morbidities
• Personal history :
-h/o chronic alcohol consumption of 180 ml per day for last 5 years and
occasionally before that
-h/o chronic tobacco consumption since 15 years
• Family history : no h/o TB/HIV contact in family
9. Clinical summary:
• 51 years, male
- with recurrent onset mid back and right girdle pain
- with acutely progressing bilateral lower limb weakness with bowel
bladder involvement
- With h/o thoracic spine surgery 3 months back with AKT
- With history of modification in AKT by local physician in view of
fever, anorexia, generalized weakness and halitosis
10. Diagnosis based on history:
• 51 years, male with 3months postoperative recurrent acute onset
paraparesis secondary to,
differentials:
- Failure of AKT or
- Multi drug resistant tuberculosis or
- Superadded pyogenic/fungal infection or
- HIV-TB
11. Examination:
• General examination:
-Patient is conscious, oriented to time place person
-Averagely built and well nourished
Pulse – 84/min
BP – 130/70 mm Hg
Respiratory Rate – 20/ min
SpO2- 98% on room air
12. -Pallor +
-Icterus +
-No oedema
-No lymphadenopathy
-No clubbing
• Systemic examination:
-CVS- S1,S2 heard and normal
-RS- Air entry equal bilaterally
-Per abdomen- soft non tender, no organomegaly, bladder not palpable
13. Spine Examination:
Gait: Cannot be assessed
Inspection:
From front, side and back in supine and lateral position in well lit room
From front:
- Head - shoulder- pelvis appears align in center
- no chest asymmetry
- Iliac crest, patella and medial malleolus appears at same level
14. From side:
No exaggerated cervical/thoracic/lumbar curves
From back:
Midline Surgical scar present extending from spine of scapula till
dorsolumbar junction
No fullness/swelling seen around the neck, over chest and abdominal
wall, over proximal thigh, gluteal region or popliteal fossa
No skin lesions or ulcers seen
Conjunctivitis and icterus +
15. Palpation:
All inspector findings are confirmed on palpation
No local rise in temperature
Deep, thrust tenderness present over scar at the level of angle of
scapula
Right sided paraspinal tenderness and bilateral para spinal muscle spasm
present at same level
20. • SI joint, Hip and knee joint examination – normal
• Distal pulsations – present
• Diagnosis:
51 years, male with 3 months postoperative recurrent acute onset flaccid
paraparesis with bowel bladder involvement with neurological level of
D8 secondary to,
- Failure of AKT or
- Multi drug resistant tuberculosis or
- Superadded pyogenic/fungal infection or
- HIV-TB
