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neck pain and stiffness abt a month

is it pott spine???? my son aged 20 years had neck pain and stiffness abt a month back followed by fever (100 to 101.6) after 3-4 days of neck pain started. on 26 mar he was put on topcef 200mg 2 tabs a day for 3 days all medicines were given to patient on 27 mar his blood was tested and report was as under TLC 12,600, DLC- NEUTROPHILS 69.2, LYMPHOCYTES 21.3, MONOCYTES 7.8, EOSINOPHILS 1.1, BASOPHILS 0.6 ESR(WESTREGEN'S) 102 S.G.P.T.(A.L.T.) 31.23 WIDAL TEST WAS NEGATIVE BASED ON ABOVE TESTS DOCTOR SUGGESTED FOR CHEST X RAY 0n 29 mar he was put on topcef 200mg tab mobizox for another 3 days all medicine wr given to patient x ray report of chest was normal but still fever (99 to 101) and pain continues doctor suggested x ray cervical spine on 29 mar report was as under straightening of spine is seen with loss of normal curvature suggestive of muscle spasm irregularity of articular surface of c5 seen prevertebral soft tissue thickening is seen cystic lesion seen anteriorly at body of c6 disc spaces are normal no cervical rib is seen ADVISED - MRI CERVICAL SPINE DOCTOR REFERRED THE PATIENT TO ORTHOPEDIC BASED ON ABOVE REPORT ortho doc put on the following treatment inj monocef 1gm I.V - BD inj Acenac MR 1 BD these injections were injected for 5 days doctor suggested for MRI cervical spine report dated 05 apr his test report was as under there is straightening of cervical spine cervicodorsal vertebral bodies from c2 to d4 level reveal focal or diffuse marrow signal intensity alterations hypointense on T1W1 and hyperintense on STIR images, suggestive of marrow edema/inflation. marrow edema is most marked in c6 vertabral bodies. large prevertabral abscess is seen in cirvicodosral region displaying hypo to isointense signals on T2W1. abscess is predominantly seen on the left side of midline involving preverbtal muscles with mild extensions on right side in right preverbtal muscles. cranially it is extending upto c2 verteba and caudally till d4 in posterior aspect of superior mediastium. abscess is also seen to extending into left c5-6 and c6-7 neural foramina with mild posterolateral wall of oropharynx and upper esophagus. CSF shows normal signal intensity. cord shows normal morphology and signal. CV junction is normal. IMPRESSION - MR imaging features aree suggeastive of infective spondylitis with large pre vertebal abscess from c2 to d4 and mild epidural extension at c6 level. Etiology - likely tubercular his blood test report dated 06 apr was as under TLC 10,600 DLC- NEUTROPHILS 68.4, LYMPHOCYTES 22.1, MONOCYTES 7.6, EOSINOPHILS 1.4, BASOPHILS 0.5 ESR(WESTREGEN'S) 110 S.G.P.T.(A.L.T.) 48.57 TSH- 2.020 BASED ON ABOVE INVESTIGATIONS and his continue temp (99 to 100) and neck pain doctor put him on AKT 4 1 kit in morning oflaxin 1 OD 400 mg tab liv 52 2tabs BD a second opinion was taken and it was suggested that patient is suffering from pott spine( cervical spine) and he put on AKT 4 daily for 1 month tab pyridoxine 10 mg daily for 1 month philadiflion collar(MGRM) also complete bed rest was advised the patient started taking AKT4 and pyridoxine from 06 apr as par above suggestion another opinion was taken and it was suggested to start phase I rest in bed for 22 hrs for 1 and half month tab Rcinex 300+600 mg daily in morning tab oflox 400 mg daily in morning shelcal-1 cobadex-1 ciplection 1 all above for 5 monthes somi brace to be worn by pateint kindly suggest if it is 100% sure that my son is infected with pott spine or any other test is reqd to be done for confirmation i want to give treatment after only 100% confirmation of the disease and not in doubt pls how can it be confirmed 3 doctors have suggested 3 types of treatment although all 3 diagnosed same disease and other one suggested for COTS sir, i m in total confusion kindly advice which medicine is the best in india for pott spine an advice from an expert doctor like u will be a real help to humankind regards pawan 9811035568
Asked On : Fri, 14 May 2010
Answers:  1 Views:  519
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General & Family Physician 's  Response
Dear pawan,
Welcome to heaithcare magic.
Given the clinical situation, it is "highly likely" that your son is suffering from tuberculous infection of spine and this will be the diagnosis unless proven otherwise. However, a 100% confirmation can only come from demonstration of acid fast bacilli on smear or a positive culture. Under CT guidance, the abscess can be aspirated and can be sent for few test- AFB smear, routine pyogenic smaer, AFB culture sensitivity, Pyogenic c/s, Pus PCR for TB. Non invasive option is to give ATT and see clinical response. However, the treatment is highly variable in spine tuberculosis, the regimen as well as duration. It is further complicated by high prevalance of MDR- multidrug resistance.
Answered: Mon, 12 Sep 2011
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