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Case of the Month - January 2014

Dr David Stead – IDSSA (thanks to Dr Nelesh Govender & Dr Sean Wasserman for their assistance)

A 16 year old girl with chronic granulomatous disease diagnosed in early childhood, on cotrimoxazole and itraconazole as primary prophylaxis, presented to a private physician with fever, neck pain, dysphagia, weight loss, and mild weakness of her hands over a few weeks. On examination there was no weakness or spasticity of her upper limbs. White cell count was normal, but her C-reactive protein was elevated at 123. Lumbar puncture was normal. An MRI spine was performed:

This was reported as enhancement of C7-T2 with volume loss of T1 vertebral body. An associated enhancing paravertebral mass without cord compression, with a large prevertebral component was noted. There were also enhancing nodules in the left lung apex and hilar region (no CXR available). Surgical evacuation of the prevertebral mass was performed.

Question 1: What infectious aetiologies would you consider?

Continue to Answer 1