#ItsTime #BreastTB

#ItsTime 21 y/o female presented with pus discharge from two openings on the right breast for last 6 years. These openings on breast had often spontaneous pus discharge followed by cessation of discharge on its own. No discharge or any abnormality of the nipple. She had already taken ATT thrice. Systemic examination was normal. Local examination showed a 1.5 centimeter opening in inferior and outer quadrant breast, through which whitish pus was discharging along with a scar superior to discharging sinus which used to discharge pus 2 weeks before. 2 firm tracts, inferior one with length of 4 cm, superior with 2.5 cm, were run posterior-superiorly ending on fifth rib. No axillary lymphadenopathy was evident. ESR was raised. Montoux test was positive. X-ray chest showed an osteolytic lesion in anterior part of fifth rib. CT shows two sinus tracts in breast tissue and the necrosed rib were seen. What will you suggest further? First line of treatment here?

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SUGGESTIVE OF TUBERCULAR SINUS ATYPICAL MYCOBACTERIA INFECTION... ADVISABLE... CULTURE. AND. SENSITIVITY BIOPSY
The history as you described two possible things came in mind as cause A. Tuberculous sinus B. Bonny involvement either bacterial osteomyelitis or Tuberculous osteomyelitis of rib Actinomycosis to be ruled out. Excision of the sinus tracts with resection of rib followed by HPE and cont treatment after biopsy and culture
It is evidently tubercular sinus You said there is lytic lesion in 5th rib underlying sinus Yes take tissue biopsy of one oc sinus for HPE and c&s Confirm the atypical mycobacterium Frequent curettage or excision of sinuses after initial 2months ATT It may require surgical osteotomy of rib.
Thanx dr Pushkar ji Bhomia
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Get a tissue biopsy done from the sinus tract and the adjoining tissue to confirm the Diagnosis of tuberculosis or Atypical mycobacterium infection. If tuberculosis is present - Start second line,ATT and after 2 months plan for surgical excision of the sinus tracts
Severe form of extrapumonary TB. HIV test must be done. Chest X ray must be done. PA aand left lateral position. Breast ultasound may be done to asses any breast related anomaly. Culture and sensitivity of the pus. Take biospsy from the sinus Start treatments
Evidently tubercular sinus Needs further investigation and evaluation for ATT and before going for surgical intervention to remove part of rib cage and excision and curettage.
Thanks Dr Pushkar Bhomia
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Another pocket of pus to be drained and treated completely. Pus culture and sensitivity to be done. Connected other pockets to be treated at once
Thanks Dr. Gupta Dr. Agrawal and Dr. Kute
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Plz evaluate for Atypical mycobacterium complex. Hiv status in such cases. Treatment according to afb culture sensitivity test
IT'S A..CASE OF.. ? TUBERCULOS SINUS.. ? TUBERCULOS OSTEOMYELITIS.. NEED'S.. PUS C AND S EXAMINATION.. TRIDOT..
Tnx Dr Vipin Bihari Jain
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Tubercular sinus HIV status of pt Evaluation for atypical mycobacterium Treatment after evaluation
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