Thanks to the mother’s diligence in second, third & fourth medical opinions and the excellent care the innocent little girl receives at City International Hospital, Quynh Anh 9 years old has a chance at life that previous generations would never receive.

The challenge with having a rare disease is that Quynh Anh (9 year-old girl)’s family is often left to figure things out as they go, regardless of how supportive their medical team is - there is no guideline. “My daughter was diagnosed with just a fever but as a mother there’s an inside voice that kept telling me that I Could not just sit down and wait but get up and fight for the life of your daughter. That was why I decided to kept on trying hospitals after hospitals.” shared Mrs. Hue-the patient's mother. Thanks to the mother’s diligence in second, third & fourth medical opinions and the excellent care the innocent little girl receives at City International Hospital, Quynh Anh 9 years old has a chance at life that previous generations would never receive.

13 April, 2019, Le Nguyen Quynh Anh (9 years old, living in Can Tho City) was brought into City International Hospital by her parents in a state of tightness, high fever, severe lumbar pain, spread. right leg on the outside of the thigh and cannot walk. According to Mrs. Nguyen Thi Hue (Quynh Anh's mother), two weeks earlier while playing around, unfortunately she fell and sprawled her spine to the side of the table. After a fall of about 2-3 days, the baby starts to complain of lumbar pain. The family sent me to a hospital in Can Tho. After an X-ray of the spine, doctors determine the normal spinal column and treat pain medication.

The situation does not improve with painkillers; the baby does not stand up straight, walks hard and starts high fever 2 days later. The family was so worried that she took me to the hospital and was admitted to a second spinal hospital in Ho Chi Minh City. With the diagnosis of unexplained back pain, doctors only treat pain and anti-inflammatory drugs. After 4 days of hospitalization here, the disease gradually worsened, the fever continued to be 40 degrees high, severe pain in the lumbar area spread to the right leg and could not walk. Too impatient, Hue asked to leave the hospital and take her to a third specialized hospital in the city. I was given the MRI by the doctors for a lumbar spine and 2 days for prescription medication. Realizing Quynh Anh’s symptoms range from mild to severe. He gets hives, blisters, itchiness, bone and muscle pain, headaches and irritability, nausea, vomiting and diarrhea. The most serious include a dangerous drop in blood pressure, rapid heartbeat, swelling and difficulty breathing. Hue again asked to leave the hospital and take her child to the fourth hospital.

Lumbar Sipnal MRI

At City International Hospital, an investigation of symptoms, signs, and imaging data, the doctor noted the girl had lumbar vertebrae or paravertebral tenderness. Pain mainly presented in the unilateral leg and/or as lower back pain, accompanied by lumbar motion restriction and sensory disturbances. an increase in C-reactive protein (CRP) levels. The imaging examination with computed tomography and/or magnetic resonance imaging manifested the occurrence of spinal trauma; MRI of the lumbar spine with magnetic contrast injection showed that L3-L4 spinal cord edema spread to the muzzle of the right L4 vertebrae and spread slightly to the right Psoas muscle. Edema contributes slightly to the right L3 and L4 nerve roots in the conjugated hole, accumulating little thorny ligament L3-L4, L4-L5.

In City Plus Program, A multidisciplinary approach including appropriate microbiological and radiological diagnosis, proper antibiotic treatment and, if needed, surgical intervention is required: Neurology, Pediatrics, Specialist of Tropical Diseases has been conducted immediately. With the diagnosis of acute pharyngeal L3-L4 pyogenic Spondylodiscitis, in which the infection spreads either through vessels anastomosing on the periphery of the annulus fibrosus or across the avascular disc by lysosomal destruction of the nucleus pulposus. The disc can be destroyed by bacterial enzymes in a manner similar to destruction of cartilage in septic arthritis. This contrasts to the tuberculous spondylitis, in which the endplates and bone can be extensively destroyed but the disc is frequently preserved due to lack of proteolytic enzymes

With further involvement of the vertebral body, the infection can extend to the epidural space, the sub ligamentous paravertebral area and contiguous vertebral bodies, i.e. the neural arch and posterior elements. However, in pyogenic infection, involvement of the pedicle, the lamina and the spinous process is uncommon and when this does occur, it should give rise to the suspicion of tuberculous infection. To limit the infection, Oral antibiotic treatment was started when CRP levels decreased to 33%after 24 hours of antibiotic treatment and/or there was no hyper intensity on MRI. she did report some initial improvement. Her abdominal pain resolved. Her antibiotics were discontinued after a three and a half week course of therapy. She denied any fevers or chills. Examination at this time revealed aggravation of pain with all directions of range of motion testing, and continued paresthesia at the lateral aspect of the right foot. Lower extremity motor power remained normal.

Dr. Dao Thi My Van - City International Hospital's Deputy Medical Director shared: Spondylodiscitis is a rare infectious disease that can only be treated with difficulty. A multidisciplinary approach including appropriate microbiological and radiological diagnosis, proper antibiotic treatment and, if needed, surgical intervention is required. In the majority of cases, surgery is needed to confirm diagnosis, to limit the infection, and to wash the surgical area. Although the diagnosis of spondylodiscitis can be made clearly via microbiological and radiological methods, its management and treatment are unclear and controversial whether it should be surgically or others believe that this is not necessary unless conservative treatment fails or an abscess or epidural mass is present, many important neurological complications that may be life-threatening can occur due to infection spreading into the spinal canal including osteomyelitis, spinal fluid abscess ... Although there have been many advances in diagnosis and treatment, the mortality rate of intervertebral cervical inflammation remains around 5%. the incidence of Spondylodiscitis can be caused by various germs from common germs to fungi and TB germs such as: Staph. Aureus, Streptococcus species, E. coli, Pseudomonas species, Proteus species, Salmonella species… Considering an active broad differential list with repeated careful neurological examination is important. Employing this strategy facilitates early diagnosis and results in prompt appropriate management, both of which are critical in suspected spinal infection. End plate injury, the cauterization of many small vessels, the presence of hematoma in the surgical area and necrotic areas due to surgery create an ideal environment for the bacteria to settle down and proliferate, many important neurological complications that may be life-threatening can occur due to infection spreading into the spinal canal including osteomyelitis, spinal fluid abscess ...  

Follow-up examination with her doctor team.

Dr. Huynh Hong Chau, the lead spine-neurosurgeon at City International Hospital, Infectious spondylodiscitis is a devastating disease that can lead to permanent neurological deficit, chronic pain, and even mortality if the diagnosis is delayed. In pyogenic spondylitis of the spine, spinal instability and kyphotic deformity can develop due to acute or chronic destructive changes of the spinal column. Both, the location and amount of vertebral body destruction play an important role in the destabilization process in the infected region. This is believed to be due to the decreased cross–sectional diameter of the cervical spinal canal in relation to the spinal cord compared with the thoracic or lumbar spine critical to life but also avoided severe complications later on such as instability, spinal deformity. The technological improvement has allowed the formulation of an early diagnosis and as a consequence, a better outcome. Dr. Huynh Hong Chau expressed great admiration for her mother's diligence and the excellent care she gave, Quynh Anh has a chance at life.

After 10 days of treatment, Quynh Anh has follow-up examination revealed full range of motion, with normal sensation and motor power to the lower extremities, fully recovered, walked, eaten and eaten normally. Because the treatment regimen of the infection of the intervertebral intercourse requires 4-6 weeks of intravenous antibiotic therapy, so in order not to interrupt school study, City Plus is planning to guide and coordinate with the hospital. local in Can tho to continue and complete the treatment course for children.

Quynh Anh reveals full range of motion, with normal sensation and motor power to the lower extremities.

Without Dr. Huynh Hong Chau at City International Hospital who is committed to finding treatments for rare conditions, Quynh Anh would likely have lost her life. The challenge with having a rare disease is that Quynh Anh’s family is often left to figure things out as they go, there is no guideline. Thanks to Dr. Huynh Hong Chau and City Plus program for discovered  allowing Quynh Anh to have a higher quality of life 

City International Hospital’s City Plus Program 

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