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Is my father suffering from Bone TB?

hi - My father aged 62 years got operated for bilingual hernia leproscopic meshoplasticity in the month of August 2010. Ever since he has been reporting stiffness in his back (hips) and in front which makes it difficult for him to sit and he finds difficult in walking (though he walks). Doctors have not been able to point out the root cause for his problem. I did some search on the Google and I think his current symptoms are probably related to Bone TB, as his ESR is increased and he has lot of stiffness on his hips and he finds difficulty while sitting. We got his MRI, bone scan and blood tests done. Does the symptoms over here point to Bone TB, and if not, what could be the root cause of his problem. My father is very much worried for his heath and any pointer would be very much appreciated. I am pasting the contents of his latest reports below. It would probably be lot of information to look for, but would really appreciate any help considering we are really worried about his health.

In case the problem does not appear to be Bone TB, then would request you to move the post to a different appropriate group who can help us out on this situation.

Any help will be very much appreciated.

Thanks,

MRI BONY PELVIS
================
MRI of bony pelvis was done on 1.5 Tesla using body-flex coil. T1W and STIR imaging was done in coronal and axial planes. T2W axial imaging was also done.
(FUC of operated bilateral inguinal hernia.)
Mild inflammatory edema is seen pubic symphysis. Mild subchondral marrow edema is seen at pubic bone and adjacent bilateral superior and inferior pubic ramii.
Patchy subchondral marrow edema is seen at bilateral ischial tuberosity. Mild edema is seen in bilateral adductor & obturator group of muscles. Mild fluid is seen along right obtuartor internus muscle.
Marrow edema is also seen at bilateral aceta buli (R>L). Fluid is seen along right pyriformis muscle with small pocket of fluid collection (measuring 16 x 5 mm).
Relatively symmetric marrow edema is seen at sacrum. No significant fluid is seen in bilateral S.I joints.
Mild fluid is seen at right iliacus muscle.
Rest of the bones show normal signal intensity and morphology.
Both femoral head and neck and proximal shaft of femur bone are normal.
Compared with previous MRI dated 18.12.2010, there is increase in marrow
edema at bilateral ischial tuberosity and acetabuli with increase in fluid at right obturator internus and right pyriformis muscles, however there is slight reduction in marrow edema at pubic symphysis and adjacent superior and inferior pubic
ramii.



BONE SCAN REPORT
====================
CLINICAL DATA: k/c/o osteomyelitis, on treatment

Radio - Isotope Bone Scan

TECHNIQUE Three phase skeletal scintigraphy of the pelvis was performed following administration of 20mci of 99mTc -MDP intravenously. Delayed images of the entire skeleton were acquired 3 hours later.

FINDINGS:

VASCUALR PHASE: There is evidence of increased flow of tracer in the bilateral ischial region

BLOOD POOL PHASE: There is increased pooling of tracer in the bilateral ischial tuberocities and right SI joint region

DELAYED SKELETAL PHASE:
1. There is abnormal increased uptake of the tracer in the following areas:

Pelvis: low to moderate grade heterogeneous tracer uptake seen in bilateral ischial tuberocities, pubic symphysis, bilateral superior pubic rami, right inferior pubic ramus and right acetabulam.
Joints: moderate grade uptake in right SI joint.

2. Elsewhere there is symmetrical and uniform tracer uptake noted in the axial and appendicular skeleton

3. Both kidneys are well visualized with normal soft tissue clearance of tracer.

COMMENTS:
EVIDENCE OF HYPERVASCULARITY, INCREASED BLOOD POOLING AND INCREASED TRACER UPTAKE IN DELAYED SKELETAL PHASE IN BILATERAL ISCHIAL TUBEROSITIES FAVOR ACTIVE INFECTION.

THERE IS AN EVIDENCE OF ACTIVE OSSEOUS PATHOLOGY SEEN INVOLVING ABOVE MENTIONED PELVIC BONES AND RIGHT SI JOINT. SUGGESTED CLINICORADIOLOGICAL CORRELATION



BLOOD REPORTS
================
HAEMATOLOGY
Haematology performed on Fully Automatic 5 part differential COULTER Haematology Analyzer
Investigation Result Unit Reference Range
C.B.C.
Haemoglobin. : 12.9 g/dl M : 13 - 18 g/dl
F : 11.5 - 16.5 g/dl

TLC : 8,800 /c.mm. A : 4000 - 11000 /c.mm.

Differential Leucocyte count.
Neutrophils : 63.9 % A : 50 - 80 %
Lymphocytes : 27.4 % A : 25 - 50 %
Monocytes : 6.9 % A : 2 - 10 %
Eosinophils : 1.2 % A : < 6 %
Basophils : 0.6 % A : < 2 %
E.S.R. (Westregen's) : 53 mm/1st Hr F : < 20 mm/1st Hr
M : < 15 mm/1st Hr


Normal Ranges : -
R.B.C. Count. : 5.09 mil./cmm M : 4.5 - 6.5 mil./cmm
F : 3.8 - 5.8 mil. /cmm

Packed Cell Volume (Hematocrit) : 39.8 % M : 40 - 54 %
F : 37 - 47 %

Platelets Count. : 329 thousand/cmm A : 150 - 450 thousand/cmm
M.C.V : 78 fl A : 76 - 96 fl
M.C.H : 25.3 pg. A : 27 - 32 pg.
M.C.H.C : 32.3 % A : 30 - 35 %
RDW : 15.0 % A : 11.6 - 14 %


Renal Profile
S. Uric Acid. : 5.07 mg/dL M : 3.4 - 7 mg/dL
F : 2.4 - 5.7 mg/dl



Anti Nuclear Antibody (IF)
(Hep-2000)
Result : Negative
Titre : 1:40



Rheumotoid Factor
(Immunoturbidimetric) : 14.47 IU/ml A : < 14 IU/ml
Rheumatoid Factor Interpretation
------------------------------------------ ----
RF are auto antibodies and IgG in nature. The presence of RF in rheumatoid arthritis gives diagnostic and prognostic
information and is regarded as a measure of inflammatory process. Highly elevated values are found mainly in
rheumatoid arthritis. Whereas low values are generally found in non specific lesions.


C Reactive Protein
(Immunoturbidimetric) : 51.10 mg/L A : < 5 mg/L
Interpretation:
Reference interval of neonates and children.
Neonates ( 0 - 3 weeks) : 0.1 - 4.1 mg/L
Childern ( 2 month - 15 yrs) : 0.1 - 2.8 mg/L
Comments:
CRP is the best known acute phase protein and its concentration rises in response to inflammatory disorders. Its
measurment is a useful tool for detection of acute infection and for monitoring inflammatory diseases. It is especially
useful in neonatal sepsis, acute rheumatic fever and gastrointestial diseases. There is a direct correlation between CRP
level and risk for developing coronary heart disease.



Anti Cyclic Citrullinated Peptide
(Anti CCP)- MEIA
Anti CCP : 2.40 U/mL
Suggested Interpretation.
< 5.0 U/mL Negative
> & = 5.0 U/mL Positive
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