###Human: Why is there a sinus tract in abdomen after cesarean? ###Assistant: Hi. I will try to help you as much as possible. A few questions first: 1. Was there any tissue biopsy done for the abdomen wall or the panniculitis lesion? If yes, please share its details. 2. Did you have symptoms of low backache and early morning stiffness, and pain in any other joints? 3. Did you have any family history of arthritis? 4. Do you take anti-inflammatory medicines in addition to Saaz for pain? Now coming to your queries: USG and MRI reports (attachment removed to protect patient identity) are suggestive of abdomen wall panniculitis, which is a chronic inflammatory condition and is mostly caused by some autoimmune process. In your case, the associated sacroiliitis may point towards the presence of spondyloarthropathy. Tuberculosis is unlikely, as it would have resolved after ATT. Bronchial asthma diagnosis needs to be worked up in order to rule out other autoimmune associations like ILD. I would like to suggest the following, if not already done: 1. HLA B27, RF, and anti-CCP. 2. ANA by immunofluorescence. 3. ENA profile. 4. ANCA (MPO and PR3 by ELISA). 5. ESR (WG) and CRP. 6. Pulmonary function tests, and X-ray chest. 7. Tissue biopsy from the abdomen and its histopathology examination. If you are finding it difficult to tolerate Saaz (Sulfasalazine), then, other drugs like Methotrexate (MTX) may be tried, but only after ruling out the possibility of ILD. MTX would also be helpful in panniculitis. for more severe pain, NSAIDs or low dose Corticosteroids may be added for short term. But it is important to establish a final definitive or most probable diagnosis.