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A 19-year-old male with HIV presents with increasing neck pain, lower extremity weakness, and constitutional symptoms over the past 4 weeks. Radiograph and MRI is shown in Figures A and B, respectively. Figure C shows a histologic specimen with Ziehl-Neelsen staining. In addition to surgical management, which of the following pharmacologic regimens is most appropriate?
Cyclophosphamide, hydroxydanurubicin, oncovin, and prednisone
Nafcillin and rifampin
Isoniazid, rifampin, pyrazinamide, and streptomycin
Denosumab, ritonavir, and efavirenz
Vincristine, actinomycin D, and cyclophosphamide
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HPI - Insidious onset gradually progressive spasticity of lower limbs since 6 years. associated weakness on lt lower limb. decreased sensation below xiphisternum.
How would you treat this patient as a FIRST LINE of treatment?
HPI - Patient under Anti Tubercular drugs for last 14 months.
After 6 months of Category 1 treatment for New Pulmonary TB, he again had sputum positive. This was drug resistance. So he was on DR TB treatment for last 8 months.
He developed weakness of limbs for last 2 months.
But weakness is more on upper limbs than lower limbs.
How would you treat this TB patient with progressive weakness?