Cold abscess
A 30yr lady came with c/o pain , swelling but no fever at right side of back since 7 days..Usg was done which suggested of an large Abscess and inspite of an large abscess Leucocyte count was in normal range...Incision and drainage was done under local anaesthesia and around 80ml pus was drained...Pus was sent for further investigations and it was found to be a cold abscess.. Chief Complaints Pain and swelling at back right side History No past history Vitals All vitals stable Physical Examination Tenderness , temperature noted Investigations CBC , hiv hbsag , hcv , Usg back , pusc/s and pus afb Diagnosis Cold abscess Management Incision and drainage under local anaesthesia
To me if there is an abscess as seen in the paravertebral region as in picture and investigation shows not suggestive of infective( bacterial) as leukocyte count is not high it was better to go for Xray of dorso lumbar spine to see any vertebral pathology or any tuberculous lesion of vertebrae. By seeing the the report decision of incision should have been taken. If positive antituberculous 4 drug regime to start Once the incision given then to continue antiburculous 4 drug regime to start with supportive ptreatment. Regular dressing may lead to tuberculous sinus may take at least 3 months to heal up.
Rifapicin450mg,daily Isonex300mh Ethambutol 800mgdsily 2month Then RH.FOIR MONTH TT OTHER SYMPTOMATICALLY
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