Fibrous dysplasia of the spine in a polyostotic form is very rare, with fewer than 36 cases discussed in the literature and there is no such case in Indonesia that has been reported. The aim of this report is to present a case from Indonesia of polyostotic fibrous dysplasia isolated in the spine. We report a case of a 38-year-old Sundanese man with a 1-year history of progressive back pain and weakness of both lower extremities. There was no history leading to infection and no previous trauma. A physical examination revealed kyphoscoliotic deformity, a caf´e au lait spot, tenderness at the thoracolumbar region, and neurological deficits. Laboratory studies were within normal ranges. Plain radiographs showed lytic lesion and kyphoscoliosis. Magnetic resonance imaging showed an endosteal scalloping, infiltrative process, expansion, and destruction in the vertebral bodies from T2 to L5. The findings of an aggressive destructive process was highly suspicious of a malignant process, relying on differential diagnosis and metastases, plasma cell myeloma, bone tumor and chronic infectious spondylitis. Histology revealed an irregularly oriented osteoid without osteoblastic rimming but surrounded by fibroblastic proliferation with a C-shaped sign. Investigations revealed a diagnosis of polyostotic fibrous dysplasia of the thoracolumbar spine in isolation. The patient underwent T5-S1 stabilization and bone grafting. At 1 year postoperative, the patient was asymptomatic; there was no recurrence and minimal neurological deficit with grade II on the modified McCormick scale. A case of the polyostotic form of fibrous dysplasia of the spine in isolation has never been reported in Indonesia. The extreme rarity of this type of presentation can pose a diagnostic dilemma, and in cases isolated to the spine, surgical treatment with posterior stabilization, decompression, and bone grafting gives a good functional outcome.
Iron deficiency remains the most prevalent micronutrient deficiency worldwide. Iron deficiency in TB patients, causes a poor outcome, reccurency, and treatment failure. Iron supplements on TB patients with iron deficiency will activate macrophage-derived monocytes (MDM) and interferon-gamma (IFN-γ), with a positive feedback mechanism pushing interleukin-12 (IL-12). This study is a single-blind randomized control trial comparing the effectivity of preoperative iron supplementation in IL-12 level between two different groups in Dr. Hasan Sadikin General Hospital Bandung, conducted from November 2018 until March 2019. Respondents are those having Spondylitis TB, with sTfR > 21,7 pg/mL and IL-12 <41 pg/mL, intensive phase antituberculosis drugs category 1. The experimental group, comprised 17 respondents, was treated with 2RHZE and 357mg iron (III) hidroxy polymaltosa. The control group was treated with 2RHZE. The sTfR and IL-12 levels were performed before and after treatment. The increase of IL-12 in the experimental group was +364,53% higher than in the control group (p<0.05). The decrease of sTfR in the experimental group was-60,68% higher than in the control group (p<0.05). The result of the Pearson correlation test was a coefficient correlation of-0,73, this showed that a decrease in the sTfR level correlated with an increase in the Il-12 level. Iron supplement in Spondylitis TB with iron deficiency in the experimental group increases the IL-12 level. Preoperative iron supplementation on spondylitis TB with iron deficiency, increases the immune system with higher levels of IL-12.
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