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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have bone tumor, lesion in proximal end. Take Anti TB drug? Perfect medication?

Hi Doctor, I’m Mr. Shahabul in Dhaka, Bangladesh; age-32, weight-53 kg, hight-5’3” and not any smoker. I was a patient of Bone TB. My case details or history is bellow. Previous history: I have felt pain on right leg upper tibia from February 2009. The pain and swelling were very slight. But while the pain was increase, swelling was increase. I went to Orthopedic for treatment. The doctor observed my X-ray film and advised me to perform some knee exercises and to take pain killer if the pain be more. I have followed only exercises but not take pain killer and felt better day by day. I have been exercised about 6 month and cured 95%. When I was irregular in exercises, felt pain increasing day by day. I have performed exercises regularly again but not improved. I went to a professor of Orthopedic again, he advised me a Test; Bone Scintigraphy: The Bone Scan Report is -Impression: Abnormal bone scan showing lesion in the proximal end of right tibia (?Neoplastic ?? Inflammatory). And the report Advice: Radiological Correction. Bone Scan date: 03-09-2009. The doctor observed the report and declared me that there is a Bone Tumor of my upper tibia. He advised me that there is no option without operation to cure the Bone Tumor and to replace another bone on the place of Tumor too. Then I have decided to operation. Operation Name: Excision of Curettage & Biopsy Doctor knew to me it is not bone tumor and no need bone replacement at the OT. Report of Tissue Biopsy (Histopathology): Tubercular osteomyelitis. Then: MT- Positive (14mm); and ESR-15 mm (1st hour) My dr. decided to me that it is a Bone TB and advised to take anti-TB medicine. I went to DOT centre to take medicine. They gave me 2FDC 3 tablets par day according to the rule of Category-I. The medicine has been taken from 31-10-2009 to 11-06-2011 date (total 19 months and 10 days) without rest. At last my dr. observed my new X-ray film and ESR-10mm (1st hour) and declared to me that I am free from Bone TB. Present History: On May-2012 (After 11 month closing the anti-TB dose), I have felt pain very slight another place of my body (Right Elbow). Once I worked for almost two hours with Hammer and my pain place increase both very pain and very swelling. The pain and swelling gradually reduces and takes 20-25 days to return previous slight Pain situation without taking any medicine. I have went to an orthopedic and bid him previous history. He advice me to some test like X-ray, ESR, MT and ALS for TB. The report of these test are X-ray: normal, ESR: 20mm (1st hour), MT: Positive (17mm) and ALS-TB: Suggestive ( antibody titer: 0.685). In this situation, my orthopedic dr. advices me to take Anti-TB drug according to Category-II rules for trail 21 days. I have gone to DOT centre to take medicine. But the TB specialist advises me that there is no scope to trail category-II patient according to Category-II Anti-TB drug rules. He also advises to me that I shall have been always followed up myself for 6 month. My symptom is slight cool feeling in bathing period, electric fanning air, fever normal according to thermometer and the pain and swelling so small that I cannot find out the exact place of pain at times. Now I want to know to you, what do I do? Can I take Anti-TB drug according to Category-II rules? If yes, what is the perfect medicine type tablet or injection? I have very pleased if give me a good advice. Thanks my Email
Sun, 16 Sep 2012
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Dear you hav taken ATT for 19 months. If drugs of good quality (Not spurious), 19 months period has least re occurrence. and that to at other site Ex R elbow. Re occurrence is common in drug resistance cases
According to cat II rules trial ATT does not carry significance.
Tissue biopsy proved from elbow for TB is gold standard of starting the ATT again
Re occurrence is common in drug
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