A Case Report Of Wide Excision Of Left Limb Tuberculosis Lymphedema

Introduction Lymphedema affect around 2 % of people in the World. The risk factor of limb Lymphedema are; Chronic infection cause; by worm (Filaria) , fungal, and bacterial (TB), history of surgery of limph node dissection, trauma of limph node, chronic venous insufuciency, Advance cancer, and congenital predisposition. Lymphedema are classified into 2 Categories; Primary Lymphedema, in which the cause is unknown. Secondary or acquired lymphedema, in which there is a clear underlying cause. Tuberculous lymphoedema is very rare, because inguinal lymph nodes are not often affected. Awareness of this manifestation of the disease is important in developing as well as in developed countries. A definitive diagnosis of TB can only be made by culturing Mycobacterium tuberculosis organisms from a specimen obtained from the patient. Diagnosis of extrapulmonary TB (EPTB) mostly depends on histological evidence. For histopathological diagnosis, presence of granulomas, caseation, and demonstration of AFB have been commonly used to define a positive test. Because EPTB is a paucibacillary disease, the sensitivity could be improved by PCR, as it can detect as few as 10 mycobacteria. Tuberculin skin test (TST) and IFN-γ releasing assay (IGRA) may be the supportive method for diagnosing EPTB, but it has a limited diagnostic value. PRESENTATION OF CASES A 38 Years old man, with masive oedema at left limb for about 3 years, that the size increase time by time. After undergo laboratorium examination, limb X Ray, and CT angio of lower extremity examination. We operated the patient to reduce the mass, by excision of the mass longitudinal until fascia, then made flaps, and reduced skin and subcutan fibrotic tissue. Evaluation after surgery there was nekrotic skin at distal cruris , after that, we did nekrotomy, and continued with STSG. 2 week after STSG, take of graft was > 95%, and the result was good. Histopathological examination of the excised specimen confirmed the diagnosis of granulomatous tuberculosis as evidenced by rice bodies. We started on Anti-tubercular Therapy (ATT) Category-1, four drug regimen (Isoniazid, rifampin, pyrazinamide and ethambutol) for 2 months and 4 months of continuation phase (CP) of two drugs (isoniazid and rifampicin) -2EHRZ/4HR. DISCUSSION Tuberculosis Lymphedema is uncomon case. The excision to reduce the mass in this patient is a challenge for the surgeon, because there was much option to treat Lymphedema, such as Complete Decongestive Therapy (CDT) with excercise, compression theraphy with garmen or Intermittent Pneumatic Compression Therapy (IPC), massage, vagetarian diet, but there is no significant result comparing each of them. Anti-tubercular therapy (ATT) Category-1 has shown favorable results CONCLUSION in this case, A 38 Years old man, with left limb Tuberculosis Lymphedema that did excision to reduce the mass and anti-tubercular therapy (ATT) Category-1 has shown favorable results.