CASE 136: COLD ABSCESS, Dr PHAN THANH HẢI, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 31 YO COMPLAINED OF PAIN AT LEFT LOWER LUMBAR REGION, DIFFICULT WALKING, FOR ONE MONTH BUT NO  FEVER.

ULTRASOUND  EXAMINATION DETECTED A BIG MASS IN THE LOWER POLE OF LEFT KIDNEY, COVERED PSOAS MUSCLE AND  STORED AT LATERAL WALL OF ILIAC CREST. ITS CONTENT WAS VISCOUS FLUID WITH  DEBRIS. 

BLOOD TEST WITH RAISING OF WBC OF 11K WITH 65 % NEUTROPHIL.

MDCT  WAS  DONE IN DISCLOSING OF MANY LESIONS OF SPINAL BONES AND ILIAC  BONE.

We think it an abscess around the destruction bone (spinal and iliac ). Puncture for aspiration is done, the withdrawed pus was in brownish color, smelless.

During aspiration, the tip of needle is made doppler color due to the flow out of the pus (see video). At the iliac crest erosive the bone made doppler artefact like twinkling.
The pus is analysis: no bacteria, no BK present in direct microscope view. But ADA test is strong positive: 126 UI/L. It make a diagnosis of COLD ABSCESS due to BONE TUBERCULOSIS. (ADA: 100% sensitive, 98% specific).

Ref on ADA: ijcri-00203201122-dikensoy.pdf