what would cause my muscles and bones to hurt and lose weight
Body aches, tender bones and rapid loss of weight: a example written report
Hadda Vijay
1Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, Bharat
Vikram Kishore Navil
1Department of Medicine, All Bharat Institute of Medical Sciences, New Delhi 110029, India
Jain Vaibhav
2Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
Anita Chopra
3Section of Haematopathology, All India Institute of Medical Sciences, New Delhi, Bharat
Ashish Goel
oneDepartment of Medicine, All India Constitute of Medical Sciences, New Delhi 110029, India
Rita Sood
oneSection of Medicine, All India Found of Medical Sciences, New Delhi 110029, India
Received 2008 Oct 7; Accepted 2009 Jan ten.
Abstract
Introduction
Bone metastases presenting with pain and body-ache may be the beginning presentation of carcinoma in nigh a 4th of patients with cancer. Radiologically majority of the metastases are osteolytic and multiple. Sometimes these may be confused with infective or inflammatory conditions, particularly in immature individuals, and degenerative weather of the spine and hip in elderly, which may delay the diagnosis and treatment leading to poor outcomes.
Case presentation
A 30 year old non-smoking male person teetotaller presented with intermittent, high-grade nocturnal fever with night sweats of one year. He besides had low back anguish over his correct hip. We establish him febrile, pale and his long basic, ribs and pelvis were tender. He had a 3 × 4 cm tender and hard swelling over the upper function of his sternum. Some other firm, non-tender swelling about iv × 5 cm was seen in the right iliac region. Radiographs of the skull, spine and pelvis revealed multiple variable sized lytic lesions. A metastatic malignancy or disseminated tuberculosis was considered. His anti-tubercular therapy was intensified Fine needle aspiration from sternal lesion showed inflammatory cells. A bone marrow biopsy showed infiltration by tumor cells suggestive of metastatic adenocarcinoma. Patient'southward condition continued to deteriorate and he died within a fortnight of his hospitalization.
Conclusion
Although masquerading every bit tuberculosis lytic lesions might exist an evidence of malignant metastatic. Although, treatment is ineffective in this phase palliative efforts to improve quality of life should be made.
Introduction
Multiple lytic lesions are a mutual radiological finding. Differential diagnoses are diverse and include infective, inflammatory and primary and metastatic malignancies. The skeletal system is the third most common site for distant metastases, following lung and liver. Os metastases may be the beginning presentation of carcinoma in about 25 per cent of patients.[i] Hurting is the common clinical presentation, which ranges from a dull ache to a deep, intense hurting that is exacerbated past weight-bearing. Occasionally, the pain is worse at nighttime and is not relieved past remainder. Radiologically majority of the metastases are osteolytic and multiple. Sometimes these may be confused with infective or inflammatory weather, peculiarly in young individuals, and degenerative conditions of the spine and hip in elderly, which may filibuster the diagnosis and treatment leading to poor outcomes. Hither we present the case of a young man with multiple lytic bone lesions.
Case presentation
A xxx year old non-smoking male patient presented with intermittent, high-grade nocturnal fever with night sweats of one year. He also had depression back ache over his right hip. Prior to hospitalization, he had received 4-drug anti-tubercular therapy (ATT) based on correct sacro-ileitis seen on magnetic resonance imaging (MRI). No change in symptoms was observed during one year of therapy and he lost 10 kg weight. He also adult a tender swelling over sternum about a month before presenting to us. Nosotros constitute him febrile, pale and his long bones, ribs and pelvis were tender. He had a 3 × iv cm tender and hard swelling over the upper function of his sternum. Some other firm, non-tender swelling virtually 4 × 5 cm was seen in the right iliac region. He had mild anaemia with normal liver/renal functions, serum calcium and alkaline phosphatase.
Radiographs of the skull (Fig 1a and 1b), spine (Fig 1c) and pelvis (Fig 1d) revealed multiple variable sized lytic lesions affecting all visualized bones. T1 weighted MRI images of pelvis (Fig 2a) revealed a hypointense mass lesion involving the right iliac bone extending into the sacrum (arrow). T2 weighted MRI images (Fig 2b) revealed that the lesion in right iliac bone was hyperintense (double arrows).
Radiographs of the skull (a, b), spine (c), and pelvis (d) showing multiple variably sized lytic lesions affecting all visualized bones.
Magnetic resonance imaging (MRI) T1W (a) image shows a hypointense mass lesion involving the right iliac bone extending into the sacrum (arrow). T2W MRI prototype (b) shows that the lesion in right iliac bone is hyperintense (double arrows).
Plain breast radiograph (Fig 3a) of the patient revealed an ill-defined mass in the left mid and lower zones, along with multiple patches of consolidation in the correct lung. Multiple lytic bony lesions were as well seen (arrows). CT scan of breast (Fig 3b and 3c) showed the lung masses (solid arrows) and lytic lesions were observed in the sternum and the vertebra (double arrows).
Chest radiograph showing an sick-divers mass in the left mid and lower zones (star), alongwith multiple patches of consolidation in the right lung. Multiple lytic bony lesions can likewise be seen (arrows). Computed tomography (CT) images (b, c) show the lung masses in detail (solid arrows). Also note the lytic lesions in the sternum and the vertebra (double arrows).
A metastatic malignancy or disseminated tuberculosis was considered. His anti-tubercular therapy was intensified by addition of a quinolone and aminoglycoside to the existing regimen. Pain was controlled with NSAIDs. Fine needle aspiration performed from sternal lesion showed inflammatory cells. A os marrow biopsy was taken from iliac crest and this showed infiltration of marrow spaces past tumor cells as shown in figure 4. The tumor was nowadays in acinar architecture. The cells were polygonal in shape. The nuclei were hyperchromatic and showed moderate degree of nuclear pleomorphism. They had moderate amount of cytoplasm. The section also showed areas of procedural bleeding. These features are suggestive of metastatic adenocarcinoma. Patient's condition continued to deteriorate and he died inside a fortnight of his hospitalization.
Section examined from os marrow biopsy showing a metastatic adenocarcinoma.
Word
Bone is the favoured site for metastasis. Most metastases are osteolytic and multiple. Although several tumors similar lung (10%), renal cell (ten%) thyroid (v%) and adenocarcinoma (5%) are associated with osteolytic lesions, breast is the most common (l%).[two] The radiographic appearance of osteoarticular tuberculosis can mimic metastatic tumors or some primary osseous lesions, such as eosinophilic granuloma, peculiarly if multiple destructive lesions are nowadays.[3] The classical presentation of renal-cell carcinoma includes the triad of flank pain, hematuria, and a palpable abdominal mass in an developed male.[4] Lung carcinoma is seen unremarkably in male person smokers, although small jail cell carcinoma tin be seen in not-smokers and besides females. Tissue biopsy from lesion can differentiate between benign and malignant every bit well equally the histopathological nature. In metastatic adenocarcinoma, as in this patient, identification of master tumour proves difficult.[5] In our case, lung was the probable master focus although this cannot be said with confirmation.
The treatment of metastatic os disease consists of either systemic or local therapy depending upon patients' functioning condition. Systemic treatment can exist chemotherapy, hormonal therapy, administration of radionuclides, or bisphosphonate therapy. The blazon of chemotherapy varies depending on the type of carcinoma. Bone lesions that progress during chemotherapy should be treated either with local irradiation or both operatively and with irradiation. The duration of survival after the diagnosis of metastatic bone illness ofttimes depends on the histological characteristics of the primary carcinoma. Patients who have metastatic os disease secondary to breast carcinoma have a better prognosis for survival (34 months) than do those who have metastatic bone disease secondary to carcinoma of the prostate (24 months), cervix (18 months), colon and rectum (13 months), or lung (<12 months) or those who accept it secondary to melanoma (about 3 months).[6,vii]
Tuberculosis (TB) is owned in this part of the globe, involving i.five% of our population.[8] Skeletal tuberculosis tin present with articular/epiphyseal, articular/metaphyseal, metaphyseal without joint or flat bone involvement. It also can nowadays as soft tissue swelling. The morphologic advent can be similar to that of a lytic tumour or a destructive articulation lesion. Soft-tissue TB presents as an abscess. On the basis of radiologic appearance, information technology can be difficult to differentiate peripheral osteoarticular and soft-tissue TB from other degenerative, inflammatory, or neoplastic disorders.[9] To forbid a delay in diagnosis, bone metastases should be considered in the differential diagnosis of multiple subversive skeletal lesions, even in young patients. If patient is not showing whatever comeback after most six–eight weeks of ATT then alternating diagnosis should be strongly considered. In our patient ATT was continued for about 12 months despite no response and because of this crucial time was lost before a diagnosis of malignancy could be made. If diagnosed before, patient may accept benefited from appropriate chemotherapy and/or radiotherapy.
Conclusion
In conclusion, our instance is unique considering he taught the states several lessons not only in the management of bone pains and body ache, an often neglected complain, just also in the humane care of a dying young patient. Although masquerading as tuberculosis lytic lesions might exist metastatic lesions from a malignant source. Treatment is normally ineffective in this stage of disease. Palliative efforts to improve quality of life may go a long way in comforting the patient.
Abbreviations
TB: Tuberculosis; CT: Computed tomography; MRI: Magnetic resonance imaging; ATT: Anti-tubercular therapy
Consent
The patient expired during the course of his treatment during hospitalization. Further attempts to obtain consent from the patient's immediate family unit members and relatives have proved futile considering they are not traceable.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
VH wrote the showtime draft of the manuscript. NKV provided intellectual inputs and was responsible for immediate patient intendance during hospitalization. AG provided continuous inputs and changes for modification to final manuscript and layout. RS was responsible for over-all patient care and provided final inputs in the manuscript. VJ analyzed and interpreted the patient data regarding the radiological picture. All authors read and approved the final manuscript.
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Articles from Cases Journal are provided here courtesy of BioMed Central
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2637836/
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