1. Chronic osteomyelitis

2. Case ชื่อ Mrs.Anab Mohamoud Adan อ. เบ็ญจ์สชีว์ ( เจ้าของไข้ ) ภูมิลำเนา : โซมาเลีย เบอร์โทรศัพท์ : 086-0104117 Dx. Chronic osteomyelitis

3. CC : แผลเรื้อรังที่ขาซ้าย 4 ปี PE : multiple discrete ulcerated nodules on sclerotic plaque on left leg

6. Tissue Biopsy ( 19/02/2557) Histopathology -Proliferation of newly-formed blood vessels within myxoid stroma and mixed chronic and acute inflammatory cell infiltration including histiocytes and multinucleated giant cells. -No granulomatous formation is indentified. -No epidermal component is seen. -No malignant feature is evident. AFB: negative Tissue C/S for mycobacteria and fungus :no growth

7. Tissue biopsy (27/01/2558) Histopathology -Proliferation of newly-formed blood vessels within myxoid stroma and mixed chronic and acute inflammatory cell infiltration including histiocytes and multinucleated giant cells. -No granulomatous formation is indentified. -No epidermal component is seen. -No malignant feature is evident. AFB : negative Modified AFB : negative

8. Tissue biopsy (27/01/2558) Tissue C/S for mycobacteria and fungus :no growth PCR for mycobacterium tuberculosis complex : negative Histologic Diagnosis Granulation tissue (may present in the tissue of chronic infection)

9. FNA (19/03/2558) AFB stain : negative Modified AFB stain : negative C/S for aerobic and anaerobic bacteria : no growth C/S for mycobacterial and fungus : no growth

10. X-ray (03/02/2558) CXR : no abnormal finding Both feet : fusion intertarsal and tarsometatarsal bones, tibiatarsal interphalangeal with sclerotic flexion deformity at left 1 st PCP Left leg : sclerotic change with multiple lucent entire left tibia with thick periosteal reaction, chronic osteomyelitis is likely

11. Lab LFT, BUN, Cr, Blood sugar : normal CBC : wbc 6,400 (N 73%, L 20%) Hb 12.2, Hct 35.5 MCV 86 Tuberculin skin test (17/03/2558) : negative Anti HIV : negative RPR : non-reactiveTPHA : negative HbsAg :negativeHbsAb : negative HBcAb : negativeHCVAb: negative FANA : positive 1:80 (speckled pattern)

12. Final diagnosis chronic osteomyelitis Current Rx รพ. ราชวิถี repeat x-ray bone และ plan ทำ bone biopsy Plan repeat FNA & c/s skin lesion อีกรอบแต่ผู้ป่วย ติดปัญหา financial problem รอจัดการเรื่องค่าใช้จ่าย