CASE PRESENTATION

CASE PRESENTATION

CASE PRESENTATION

This 13year old male who happened to be the son of a poor subsistence farmer was seen in one of our free rural medical outreaches at Patani in Delta State, Nigeria. He presented with right knee swelling of 3years duration.

The swelling has progressively increased in size with associated pain which was worse in the morning and when walking, non-radiating nil-discharge, there is associated swelling in the right groin. Nil weight loss, yellowness of the eyes, nil cough. Previous treatment is in a traditional place (native doctor) with scarification

On examination: child, not pale, anicteric, afebrile

Right knee swollen, deformed with scarification marks, nil sinus or discharge, nil differential warmth, limited knee movement swelling not attached to skin.

Right groin-has multiple freely mobile rubbery lymph nodes that is tender, but not attached to underlying structure on skin. There is also bilateral axillary lymph node enlargement.

LABORATORY INVESTIGATIONS

Full blood count done showed:

PCV-34%

WBC-700 cells/mm3

PLATELETS-355, 000cells/mm3

NEUTROPHIL-46%             40%-75%

LYMPHOCYTES-31%                      20%-40%

EOSINOPHILS- 10%                       1%- 6%

BASOPHIL     -20%              0%-1%

MONOCYTES -13%                        2-10%

ESR-              – 40mm/l       (0-10mmlh)

HEAMOGLOBIN GENOTYPE–    AA

Lymph node biopsy showed chronic granulomatous lymphadenotis most probably of tuberculous origin.

He was then commenced on antikoch’s regimen.

I

Patient Before Surgery (Arrow indicating swelling on the Right Leg)

Incision Biopsy in Progress

Incision Biopsy in Progress

Incision Biopsy in Progress2

Incision Biopsy in Progress

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