Description
● Overview of the Case:
The patient is a 35-year-old man who was previously in good health.
➣ The main complaints are:
• A gradual body soreness and non-inflammatory, non-traumatic back discomfort that doesn't go away even while you're at rest;
• A low-grade evening temperature increase that has persisted for nine months.
➣ Pain features include:
• Involved dorsal, lumbar, and sacral areas;
• Chronic, dull, and persistent;
• Not alleviated by rest or analgesics.
➣ No history of neurological impairments, respiratory problems, trauma, TB contact, or weight loss.
● Clinical Assessment:
➣ General Examination:
• No postural hypotension, mild anaemia, and stable vital signs.
• No hepatosplenomegaly or ascites, and the lungs are clean.
➣ Musculoskeletal Examination:
• No gibbus, deformity, or paraspinal oedema was found, although there was localised discomfort over the dorsal, lumbar, and sacral spine.
• There is no neurological impairment.
● Imaging and Radiological Results:
➣ Multiple lytic lesions involving the dorsal, lumbar, and sacral vertebrae are seen on the MRI spine.
• Skip lesions, a sign of multifocal skeletal involvement, are present.
• Soft-tissue abscesses in the paravertebral region are visible (Figure 4).
➣ Bone Scintigraphy (Tc-99m MDP):
• The sacrum, iliac bones, sternum, manubrium, and T7–L5 vertebrae all exhibit heterogeneous tracer uptake.
• Verifies skeletal activity that is multifocal and suggests infection rather than metastases.
● Microbiological and Cytological Results:
➣ CT-guided Fine Needle Aspiration Cytology (FNAC):
• Dispersed epithelioid histiocytes with a backdrop of caseous cellular debris were seen, which is consistent with inflammation caused by tubercular glycosis.
• No signs of myelomatous alterations or neoplastic cells.
★ Final Diagnosis:
➣ Multifocal Skeletal Tuberculosis (Disseminated Osteoarticular TB) affecting the iliac, lumbar, and sacral vertebrae, as well as the sternum.
Protocol
● Treatment and Management:
➣ Antitubercular Therapy (ATT):
• Started with dose modifications for CKD.
• Standard 4-drug regimen: Pyrazinamide (changed dose schedule), Ethambutol, Rifampicin, and Isoniazid.
➣ Supportive Management:
• Electrolyte imbalances and anaemia correction.
• Nutritional assistance for gaining weight.
• Fluid restriction and routine nephrology follow-up are two CKD-specific treatment strategies.
➣ Relieving symptoms:
• Haematinic supplements and antiemetics;
• Proton pump inhibitors to lower the risk of more bleeding.
● Nursing Management Techniques and Interventions :
→ These issues are addressed by evidence-based nursing interventions:
➣ Personalised Patient Education: Nurses offer patients individualised instruction to help them manage chronic conditions like diabetes and heart failure on their own, which improves treatment compliance and clinical results.
➣Medication Management: Nurses increase adherence and decrease medication errors through reconciliation and routine reviews, which lowers adverse events and readmissions to the hospital.
➣Infection Control: Strict isolation and hand hygiene guidelines are used to prevent the transmission of illnesses and drastically lower the number of infections linked to healthcare.
➣Pain Management: To reduce pain intensity and enhance patient satisfaction, non-pharmacological methods (such as music therapy) and patient-controlled analgesia are employed.
➣Continuing Nursing and Follow-Up: Platforms for managing chronic diseases and frequent reminders (like SMS follow-ups) guarantee that patients keep their appointments and care plans, providing continuous support and direction.
➣Psychological Support: To improve patients' mental health and promote resilience and a positive attitude towards treatment, regular counselling and emotional support are offered.
➣Team-Based Care: Nurses play a key role in coordination, and regular interdisciplinary team meetings assist coordinate treatment plans and promote consistency in care.
Notes
For more details visit https://doi.org/10.1016/j.clinpr.2024.100383