Beware of First Impressions

A CLINICAL PROBLEM-SOLVING article by Oluwaseun Falade from Johns Hopkins Bayview Medical Center, Baltimore.
A 64-year-old Filipino man presented to a Baltimore hospital with a 4-month history of worsening midback pain, progressive leg weakness, and intermittent bladder and bowel incontinence. He had no fever or pulmonary symptoms. MRI of the thoracic spine revealed hypointense T1-weighted and hyperintense T2-weighted bone marrow signal involving vertebral bodies T2, T3, and T4 findings that were consistent with osteomyelitis; vertebral compression fractures; an epidural fluid collection; and spinal cord compression.
Multiple blood cultures were negative. Because the spine was considered unstable, he underwent T2, T3, and T4 vertebrectomy with fusion from C3 to T8. Pathological studies of the operative specimen revealed granulation and chronic inflammation. No organisms were identified with the use of routine or special stains.
A purified protein derivative (PPD) test was positive, with 12 cm of induration. A chest radiograph did not show cavitary disease or other findings suggestive of pulmonary tuberculosis. On the basis of the clinical presentation and the results of the PPD test, a presumptive diagnosis of vertebral tuberculosis was made, and a regimen of ethambutol, isoniazid, pyrazinamide, and rifampin was started.
The patient then returned to the Philippines. There, despite reporting adherence to his antituberculosis regimen, he began to have high temperatures and drenching night sweats, and he lost 30 lb.

結核と思ったときには、「類鼻疽(melioidosis)」も考慮しましょうってことです。日本も人口減少を補うため、海外からの移民を受け入れることを免れないでしょうから。