Date: Wed, 6 Dec 2006 11:03:49 -0800 (PST)
From:  "Rajendra Mehta" (r_u_mehta@yahoo.com) 
Subject:  ?Brucellosis spine
To: "Bhavin Jankharia" <bhavin@jankharia.com>
CC: "Ma Zhen-sheng" <mazhensheng@yahoo.com>, "Dr.Sotiris Pappastefanou" <sotiris@doctors.org.uk>, "Dr.Ram Chaddha" <orthoram@vsnl.com>

--Hello Dr. Bhavin,

Thanks for the previous mail. This is an interesting case and I am still doubting if it is a clear case of Koch¡¯s spine.

Sending you images of a 60 years old male patient c/o dorsal spine pain with radiation aong the intercostals nerve.for last two and half months. I very much wish to have your valuable opinion in this situation as even though it looks like it is Koch¡¯s spine, I still feel one needs to rule out brucellosis and acute pyogenic discitis. The presentation was very acute in mid September. The patient has lost nearly 14 kg weight but still has a good appetite. He does not have fever and does not look toxic or sick, He occasionally has night pains. There is no distal radiation of pain. The ESR is 90/120 and neutophil count is 73% and lymphocytes is 25%. The FNAC report is acute inflamation.I shall appreciate if you guide me for the differential diagnosis in this situation.

With best wishes,

Regards,

Dr.Rajendra Mehta