Case fungal osteomyelitis.
-
Upload
isra-institute-of-rehab-sciences-iirs-isra-university -
Category
Health & Medicine
-
view
120 -
download
1
Transcript of Case fungal osteomyelitis.
![Page 1: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/1.jpg)
FUNGAL OSTEOMYELITIS OF ZYGOMATICO MAXILLARY
COMPLEX – A RARE CASE
Dr. Ghulam SaqulainM.B.B.S., D.L.O., F.C.P.S
Head of Department of ENTCapital Hospital, Islamabad
![Page 2: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/2.jpg)
CASE HISTORY
Name: Khawaja Abdul Rehman Age: 55 Years Sex: Male Admission No: 2569 Card No: 10827 PD Address: H.No 8041, Sadiq
Abad Rawalpinndi DOA: 04.03.04 DOD:
16.03.04 DOA: 09.04.04 DOD:
16.04.04 DOA: 25.5.05 DOD:
29.06.05
![Page 3: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/3.jpg)
Presenting Complaint: Swelling below the Eye 5 months
Past History: Medical No history of any significant
disease No history of allergy Surgical Not significant
Family History: Nothing Significant
Personal History Married, 3 sons and 4 daughters. No addiction.
![Page 4: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/4.jpg)
EXAMINATIONGENERAL PHYSICAL EXAMINATION
A old man sitting anxiously in bed, well oriented to time, place and person.
Anaemia Jaundice Clubbing
Absent
Cyanosis Palpable Nodes
Contd.
![Page 5: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/5.jpg)
Temp: A febrile
Pulse: 84 beats per min. Regular,
BP: 130/80 mm Hg.
…GENERAL PHYSICAL EXAMINATION
![Page 6: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/6.jpg)
SYSTEMIC EXAMINATION
Resp. System: CVS:
NAD CNS: GIT:.
![Page 7: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/7.jpg)
E.N.T EXAMINATION
NASAL EXAMINATION
Inspection: Anterior Rhinoscopy: Normal Mucosa, turbinates and septum
noted. Posterior Rhinoscopy: NAD
Palpation: No Tenderness over cheeks
EXAMINATION OF THROAT
Poor oral hygiene
EXAMINATION OF EARS Normal findings noted.
![Page 8: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/8.jpg)
LOCAL EXAMINATION Revealed a small ovoid
swelling 1 cm x 1.5 cm on and below the lateral part of right infra orbital region. The swelling was cystic in consistency with poorly delineated rounded margins. No signs of inflammation noted. Swelling was immobile
![Page 9: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/9.jpg)
INVESTIGATIONS CP 15.03.04
WBC 6600 ul NE% 63% Ly% 28% MO%06% EO% 03%
Hb 15.4 g/dl PLT 136,000 ul
ESR 07mm/1st hr. HCV Ab Negative HBs Ag Negative
FBG 100 mg/dl(Range60 -110mg/dl)
RBG 145mg/dl (Range110-160mg/dl)
Montoux Test: -ve Urea 47 mg/ dl Creatinine 1.7 mg/dl ALAT 33 U/L Alkaline Phos. 117 U/L Total bilirubin 1.9 mg/dl
![Page 10: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/10.jpg)
Plain Radiograph of PNS No bone erosion
noted
X-Ray Chest Normal.
![Page 11: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/11.jpg)
Provisional Diagnosis: Infra-Orbital Cyst
Treatment: Inj. Ceftim 1 gm I/V BD Tab. Mytil 500 mg BD
![Page 12: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/12.jpg)
Fluid Aspirated For Cytology/ Culture sensitivity (4.3.4) Fluid Cytology: Findings consistent
with Acute Inflammation/ Abscess were noted
Culture Sensitivity: No organism found after 48 hrs incubation at 37 degree C.
![Page 13: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/13.jpg)
Follow Up
Swelling Reappeared soon after discharge of patient from hospital
Patient Readmitted for Excision Biopsy
![Page 14: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/14.jpg)
Surgical Exploration
Surgical Exploration was planned after due preparation
Procedure: On Exposure through a horizontal incision
on right infra orbital region, a collection of pus was found under the periosteum.
Drainage of pus was performed along with curettage of bone underneath.
![Page 15: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/15.jpg)
Antral lavage performed, which did not reveal any collection of pus in Maxillary Sinus. Also no communication was noted between the sinus wall and cyst cavity.
Samples sent for histopathology and Culture Sensitivity
More extensive surgery deferred pending further investigations.
![Page 16: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/16.jpg)
![Page 17: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/17.jpg)
Post Operative Treatment: Antibiotic
In Ward Inj. Ceftim 1 gm I/V BD Inj. Ampicillin 500 mg I/V TDS
On Discharge Tab. Mytil 500 mg BD Cap. Kefril 500 mg TDS
Analgesics Stitches Removed after a week
![Page 18: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/18.jpg)
Histopathology (21.04.04) Chronic Non Specific Inflammation
Culture Sensitivity Growth of Staph coagulase negative(Probably skin commensal flora?)
![Page 19: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/19.jpg)
Wound transformed into a sinus discharging blood and pus.
There was no or little response to different groups of antibiotics.
Therefore Further investigations were planned.
![Page 20: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/20.jpg)
Repeat X-Ray PNS: (8.8.04)
![Page 21: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/21.jpg)
CT Scan31.05.05
Destruction of zygomatic arch and part of anterior wall of maxilla noted on the right side.
Sinus tract was visualized
Peri-orbital fat and muscles appear normal
Maxillary antrum, Infra temporal fossa appears normal.
![Page 22: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/22.jpg)
Findings are Compatiable with Chronic Osteomyelitis
![Page 23: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/23.jpg)
Operation (18.06.05) Wound Debridement +
Sequestrectomy + Curettage of underlying bone + Bone surface polished with diamond burr.
![Page 24: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/24.jpg)
![Page 25: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/25.jpg)
![Page 26: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/26.jpg)
Histopathology (20.06.2005) Lab #: H-335-05.
Chronic Osteomyelitis due to Fungal Infection. The morphology of hyphae is suggestive of Aspergillus
sp.
![Page 27: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/27.jpg)
Medical Treatment: Tab. Nizoral 400 mg BD. 6 weeks
![Page 28: Case fungal osteomyelitis.](https://reader033.fdocuments.in/reader033/viewer/2022052522/554b93f0b4c905764c8b456d/html5/thumbnails/28.jpg)