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A CLINICAL CASE OF A RARE TUBERCULOUS LESION OF THE RIB
Pardaeva Uguloy Djamalovna
Samarkand State Medical Institute, Samarkand, Uzbekistan
The rarest localization of tuberculosis of flat bones is the ribs and sternum. The specific lesion of
the ribs is caused by the close contact of the chest organs: the lymphatic and circulatory systems of
the pleura, lungs, and heart. In the literature data, cases of the middle ribs damage, mainly the
anterior surface, are given. The erasure of clinical symptoms and reduced alertness towards
tuberculosis, leads to a complicated course of a specific lesion.
In our clinical case, the patient is 26 years old, a resident of a rural area. He was admitted to the
extrapulmonary surgical department of the Samarkand anti-tuberculosis dispensary. Patient
complaints: non-healing postoperative wound on the right in the lower part of the chest nonhealing
postoperative wound with periodic purulent discharge, swollen formation in the right axillary
region. From the anamnesis: since 2014, he was in emigration in Russia. In November of 2018, he
was treated at the place of residence. A painless lump-like formation on the back was dissected
twice with an interval of 2-2.5 months, followed by rehabilitation of the absceding cavity and
drainage, against the background of anti-inflammatory therapy. Six months later, the patient felt
the enlarged lymph nodes in the right axillary region with the repeated appearance of swelling at
the site of the postoperative scar. Histological examination of enlarged axillary lymph nodes
revealed a change characteristic of a specific process. The fistulogram with multispiral tomography
revealed: a branched sinuous fistula with multiple pockets and cavities in the muscles of the
posterior-lateral part of the chest. Laboratory examination of purulent discharge from the back and
axillary lymph node by Xpert MBT/RIF and luminescence microscopy revealed Mycobacterium
tuberculosis (MBT) sensitive to rifampicin.
In the surgical department of extrapulmonary tuberculosis, against the background of chemotherapy
from 4 first-line antibacterial drugs, the patient underwent necroectomy of the XI rib on the right,
necroectomy of the arches of the spinous processes, followed by drainage of the TH 11-L 2-3
vertebrae. A revision of the paravertebral back muscles was performed, with excision of two
postoperative fistulas, and removal of suppurated axillary lymph nodes on the right. Histological
examination of the surgical material revealed giant Pirogov-Langhans cells, caseous detritus, and
MBT.
Conclusions:
this clinical case can serve as another proof that, for the diagnosis of tuberculosis, it
is necessary to conduct complex X-ray examination methods using more sensitive laboratory
methods for detecting MBT and histological examination methods to detect specific changes. It
should be considered by general practitioners and doctors of narrow specialties, that is, medical
specialists of different ranks and directions that tuberculosis can affect all organs and systems of
the human div.
References
1.
Ганиев, К. Г., Т. А. Вавилова, and Н. А. Салахутдинова. "Санаторное лечение детей,
больных туберкулезом в сочетании с неспецифическими заболеваниями
легких." Проблемы туберкулеза 4 (2000): 34.
2.
Галиулин, Т. И. "КЛИНИЧЕСКОЕ ТЕЧЕНИЕ ТУБЕРКУЛЕЗА ЛЕГКИХ У
БОЛЬНЫХ С КОМОРБИДНОЙ ПАТОЛОГИЕЙ." Фундаментальная наука и
клиническая медицина-человек и его здоровье. 2020.
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3.
Агзамова, Шоира Абдусаламовна, and Фируза Мирзакировна Ахмедова. "ФАКТОРЫ
ВОСПАЛЕНИЯ, КАК ПРОГНОСТИЧЕСКИЕ МАРКЕРЫ ФОРМИРОВАНИЯ
ЭССЕНЦИАЛЬНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ У ДЕТЕЙ." Children's
Medicine of the North-West 8.1 (2020): 31-32.
