70 y/o Female, Generalized weakness, Bipedal edema, On-and-off afternoon
fever, Anorexia, Back pain, Easy Fatigability, Sluggishness
PHYSICAL EXAMINATION:
1. Tachypnea
2. Hypotension
3. Poor skin turgor, sunken
eyeballs
4. Pallor
5. Limitation of motion of
both lower extreities
Pott’s Disease
 70 year-old, female, with a history of pulmonary
tuberculosis
 the most common presenting symptoms of spinal TB
were persistent spinal pain and local tenderness,
limitation of spinal mobility, febrile state, and
neurologic complications including paralysis and other
symptoms including malaise, weight loss, and fatigue
(the patient presents with fever, upper back pain and
limitation of movement of the lower extremities )
 spinal tuberculosis is a chronic and slowly progressive
disease with prolonged symptomatology (patient’s
presenting symptoms started 4 months prior to
admission)
 x-ray of the spine shows nonspecific degenerative
changes (thoracolumbar x-ray of the patient showed
degenerative osseus changes)
 spinal TB is the most common form of skeletal system
TB, comprising 50% of all cases
 Cannot totally rule out, gold standard for the diagnosis
of patients with suspected spinal TB is CT guided
needle aspiration biopsy; the samples obtained should
be assessed with stains for acid fast bacilli, culture and
histologic examination.
LABORATORY TESTS:
↓HGB, ↓HCT, ↓RBC,
↑WBC (Neutrophilia),
↑Glucose, ↓Albumin,
↑Globulin, ↑ALP, ↑
Corrected Ca, ↓Na ,K, Cl
Hepatocellular Carcinoma
 Common in Southeast Asia
 Abdominal pain
 Multiple heterogenous complex masses in parenchyma of
right liver lobe
 Small liver (upon UTZ) may indicate cirrhosis:
o Cirrhosis commonly associated with multiple
nodular form of HCC
o Cirrhosis from any cause as risk factor of HCC
 Hepatic decompensation in patients with cirrhosis
including ascites and peripheral edema
 Hypercalcemia (paraneoplastic syndrome)
 Weight loss, anorexia, lethargy, fever (nonspecific
symptoms are common)
 Absence of jaundice may be due to lack of invasion of the
common bile duct
 Bone pain seen in 3-12% of patients (Fauci et. Al.)
 No hepatomegaly (most common symptom of HCC) and
splenomegaly (indicates portal hypertension)
 No other signs and symptoms of chronic liver disease
(dilated abdominal veins, palmar erythema, gynecomastia,
testicular atrophy, pruritus)
 Liver function tests normal except elevated alkaline
phosphatase
 Lytic lesions in skull suggestive of multiple myeloma than
bone metastases of of HCC
 Severe anemia not a common finding in HCC
 Miliary TB Multiple Myeloma

 70 year-old, female, with a history of pulmonary General Data:

tuberculosis
 may mimic many diseases  70 y/o
 adults older than 65 years have a higher risk of miliary
TB Chief Complaint:
 most deaths occur within the first 2 weeks of
admission to the hospital  Generalized weakness
 patients with miliary tuberculosis (TB) may experience
progressive symptoms over days to weeks or HPI:
occasionally over several months; symptoms include
weakness and fatigue (90%), weight loss (80%)  Anorexia
 subtle signs, such as fever (80%), cough (60%) may be  Easy fatigbility, generalized weakness,
observed sluggishness
 alkaline phosphatase levels are elevated in  Upper back pain
approximately 30% of cases  Fever
 elevated levels of transaminases suggests liver
involvement ROS:

 Dizziness on sitting up
 CBC count: leukocytosis may be present; patients may  Upper back pains
have anemia; thrombocytopenia may be present
 sputum induction has low sensitivity; findings are Past Medical Hx:
smear-negative and culture-negative in 80% of  Hospitalization due to osteoporosis
patients because of hematogenous spread
PE and Lab Tests in the ACU:

1st Hospital Day

Cannot totally rule out:
 Cultures for mycobacteria of other body fluids is
 Weakness (stretcher-borne)
essential (e.g. sputum, urine, cerebral spinal)
 Fever
 Chest CT scan is useful in in the presence of  Painful/tender sacral deformity (suggestive of
suggestive, but inconclusive chest radiography findings fracture)

2nd hospital day

 Anemia
 Fever

3rd hospital day

 Degenerative osseous changes in thoracolumbar

xray
 Pallor (anemia)

4th hospital day

LEGEND:
 Corrected calcium markedly elevated (2.78)
Page Connector
5th hospital day
Ruled out
Rule out features

Pertinent features
Rule in features of the case