Case of H.C.

Pedia-Ortho SGD

General Data

• H.C.• 6 years old• Male• From Urdaneta• R flank mass and R inguinal mass

History of Present Illness– Diagnosed case of Pott’s disease since

March 2009, currently on his 3rd month of treatment with HRZE

– Patient was referred to Rehab for fabrication of TLSO brace, because patient will need brace immediately post-op

8 mos PTA (Nov 2008)• Patient’s mother noted 1x1cm mass on

the R lower lumbar area. The mass was movable, fluctuant and non-tender. No consult was done.

7mos PTA• The mass was noted to be enlarging,

occupying the lower lumbar area, with associated 50% weight loss and anorexia, occasional cough, undocumented fever (Paracetamol) and night sweats.

3mos PTA• Continuous increase in size of the mass

and fever prompted consult to a private doctor. Chest X-ray was done which revealed PTB. Patient was started on Anti-Koch’s medications (HRZE)

1week PTA• Patient’s mother noted the presence of

– 3x4cm soft, non-tender, non pulsatile R inguinal mass

– 6x5cm soft, non-tender non-fluctuant R flank mass

• Patient was brought to the ER and was advised for admission

Review of Systems(+) fever (+) unprod cough (-) abd’l pain(+) weight loss (-) colds (-) BM

changes(+) anorexia (-) dyspnea (-) GU changes(-) headache (-) orthopnea (-)

dysuria(-) nausea (-) chest pain(-) vomiting (-) easy fatigability(-) BOV (-) easy bruisability

Past Medical History

• (-) previous hospitalization• (-) allergies• (-) other illness

Family Medical History

• (-) DM, BA, HD, thyroid disease• (+) HPTN- maternal

Birth and Maternal History

• Born FT to a then 26y/o mother G2P1(1001) via NSVD in a lying-in clinic assisted by a midwife. With regular PNCU’s c/o local health center. Mother denies any maternal illness, (-) fetomaternal complications.

• Patient was born with good cry and good suck

Personal and Social History

• Middle child, w/ 10yo brother and 3yo younger brother

• Mother 32yo, housewife• Father 35yo, tricycle driver

Nutritional History

• Patient was exclusively breastfed until about 1 year of age

• (+) complimentary feeding started at 6-8 months old

Immunization History

• BCG• DPT 3doses• OPV 3 doses• Hep B 3 doses• Measles• c/o Local Health Center

Developmental History

• Generally at par with age• Grade 1 student

Physical Examination

General

• Alert, awake, conscious, not in cardiorespiratory distress

• HR= 140’s• RR= 38• T= 38.4 C

HEENT• Slightly pale palpebral conjunctivae,

anicteric sclerae, (-) NVE• (+) multiple CLAD

Chest and Lungs

• Clear breath sounds• (-) use of accessory muscles• (-) suprasternal/ intercostal retractions

Heart

• Adynamic precordium• Distinct heart sounds• (-) heaves, thrills,murmurs

Abdomen

• Firm and globular abdomen• NABS• Non-tender, (-) masses• Non-palpable liver edge, intact

Traube’s space

Extremities• Pulses full and equal, CRT<2s• DTR’s: normoreflexive• Full ROM’s • MMT:

– C5-T1: 5/5– L2-S1: 5/5

• Sensory: (-) sensory deficits– C5-T1: 100%– L2-S1: 100%

Present Working Impression

Pott’s Disease, ongoing treatmentAbscess R paravertebral area with psoas

extension– s/p Anterior Debridement,

Decompression and Interbody Fusion T11-L1 (7/6/09, PGH)

Medications on Board

• Isoniazid• Rifampicin• Paracetamol PRN• Clindamycin

Thank you!