Khan Imran, Mufti Ahmad Jawad, Khan Mah Muneer, Khan Attaullah, Afridi Humaira, Jan Hizbullah
Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan.
J Ayub Med Coll Abbottabad. 2018 Oct-Dec;30(4):605-607.
A 45-year-old diabetic male who was a farmer by profession, presented to Khyber Teaching Hospital with swelling and redness on the right side of the chest at the level of 8th rib for the past 5 months which was accompanied by fever and pain. He went to a local hospital where he was given broad spectrum antibiotics. He presented again with yellowish discharge from the wound. Dressing of the wound was done and he was referred to Khyber Teaching Hospital. On presentation, there was an open wound of about 4 cm on the right side of the chest wall at the level of 8th rib near the midclavicular line. X-ray revealed a lytic bone lesion near the costo-chondral junction of the 8th rib. CT scan also showed erosive changes at the above mention site. His fasting blood sugar was well above the normal range and his Alkaline Phosphatase was slightly raised. He was started on Insulin. Debridement and dressing were done and samples were taken for investigations. Bone tissue biopsy revealed inflammatory non-caseating tissue. Culture report was positive for Salmonella Typhi which was resistant to Ciprofloxacin. The patient was given antibiotic (co-amoxiclave) treatment to which he responded leading to a satisfactory recovery.
一名45岁职业为农民的糖尿病男性患者，因右侧胸部第8肋水平处肿胀、发红5个月，伴有发热和疼痛，前往开伯尔教学医院就诊。他曾前往当地医院，在那里接受了广谱抗生素治疗。之后伤口又出现黄色分泌物，对伤口进行了换药处理，并被转诊至开伯尔教学医院。就诊时，右侧胸壁第8肋水平靠近锁骨中线处有一个约4厘米的开放性伤口。X线显示第8肋肋软骨交界处附近有骨质溶解病变。CT扫描也显示上述部位有侵蚀性改变。他的空腹血糖远高于正常范围，碱性磷酸酶略有升高，开始使用胰岛素治疗。进行了清创和换药，并采集样本进行检查。骨组织活检显示为炎症性非干酪样组织。培养报告显示伤寒沙门菌阳性，对环丙沙星耐药。给予患者抗生素（阿莫西林克拉维酸）治疗，患者对此有反应，最终实现了满意的康复。
