52F Rt.UL Cavity ; TB ; DM
Case History and Clinical Findings:-
C/O FEVER AND COUGH SINCE 4 MONTHS , GENERALISED WEAKNESS SINCE 1 MONTH.
history of present illness:-
PATIENT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS BACK THEN SHE DEVELOPED FEVER AND COUGH.
FEVER WAS LOW GRADE AND NOT ASSOCIATED WITH CHILLS AND RIGOR, INTERMITTENT IN NATURE,RELIVED WITH MEDICATION ,NO DIURINAL VARIATION. COUGH SINCE 4 MONTHS ,NON PRODUCTIVE,DIURINAL VARIATION PRESENT( INCREASED DURING NIGHT),NO SEASONAL VARIATION.
H/O WEIGHT LOSS SINCE 4 MONTHS (5-6 KGS).
NO WHEEZE ,SOB.
NO H/O VOMITINGS,LOOSE STOOLS,PAIN ABDOMEN.
NO H/O PALPITATIONS,PEDAL EDEMA
O/E:
PATIENT IS C/C/C
PALLOR +
NO SIGNS OF ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY,EDEMA
VITALS:-
TEMP:98.5F
PR:96BPM
RR:20 CPM
BP:110/70 MM HG
SYSTEMIC EXAMINATION:-
RS-TRACHEA CENTRAL, B/L AIR ENTRY PRESENT NORMAL VESICULO BRONCHIAL SOUNDS CREPTS IN INFRACLAVICULAR REGION.
CVS: S1 S2 HEARD
P/A: SOFT, NON TENDER
CNS: NFND
REFERALS:-
PULMONOLOGY REFERAL:-
I/V/O FEVER AND COUGH SINCE 4 MONTHS (?PTB).
ADVICED-SYP. GRILINCTUS DX 2 TABLE SPOONS PO/TID.
INDUCE SPUTUM FOR SPUTUM C/S,GRAM STAINING,AFB.
OPHTHALMOLOGY REFERAL:-
I/V/O DIABETIC RETINOPATHY.
IMPRESSION- NORMAL
ANTERIOR SEGMENT AND FUNDUS IN BOTH EYES .
NO FEATURES SUGGESTIVE OF DIABETIC RETINOPATHY AS OF NOW.
COURSE IN THE HOSPITAL: - PATIENT CAME TO OPD ON 17/5/23 WITH C/O FEVER(INTERMITTENT) AND COUGH SINCE 4 MONTHS. CHEST XRAY SHOWN A CAVITY IN THE RIGHT UPPER LOBE.AND SHE GOT ADMITTED . ON 18/5/ 23 SPUTUM SENT FOR C/S ,GRAM STAINING,AFB BY INDUCING SPUTUM WITH NS IN NEBULISER . PULMONOLOGY REFERAL TAKEN ,THEY ADVISED TO INDUCE SPUTUM FOR TESTING. DUE TO SCANTY SPUTUM BAL WAS DONE ON 19/5/2023. IN BAL - GRAM STAINING - FEW EPITHELIAL CELLS, MODERATENUMBER OF PUS CELLS. OCCASIONAL GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS,OCCASIONA GRAM NEGATIVE BACILLI SEEN. - ZN STAIN- ACID FAST BACILLI SEEN. - CBNAAT SPUTUM AND BAL - RIFAMPICIN SENSITIVE MTB DETECTED. FROM 20/5/23 ONWARDS ATT STARTED.
provisional Diagnosis:-
PULMONARY KOCH'S WITH RIGHT UPPER LOBE CAVITY WITH TYPE 2 DM
Investigation:-
CHEST XRAY :-
RETICULONODULAR OPACITIES IN UPPER AND MID ZONES OF B/L LUNG FIELDS, ON RIGHT SIDE EXTENDING TO HILAR REGION. CAVITY WITH SURROUNDING CONSOLIDATORY CHANGES IN UPPER ZONE OF RT. LUNG.
IN BAL - GRAM STAINING - FEW EPITHELIAL CELLS, MODERATENUMBER OF PUS CELLS. OCCASIONAL GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS,OCCASIONA GRAM NEGATIVE BACILLI SEEN.
- ZN STAIN- ACID FAST BACILLI SEEN.
- CBNAAT SPUTUM AND BAL - RIFAMPICIN SENSITIVE MTB DETECTED.
2D ECHO:-
NO MR/AR/TR NO RWMA. NO AS/MS
GOOD LV SYSTOLIC FUNCTION.
DIASTOLIC DYSFUNCTION +,
NO PAH / PE
HAEMOGRAM: - HB-9.7 GM/DL
TLC-11,800 CELLS/CU.MM
NEUTROPHILS- 86%
LYMPHOCYTES -09%
PCV- 31.7 VOL%
RBC-3.7 MILLIONS/CU.MM
PLT-3.32 LAKHS/CU.MM
22/5/2023- HB-9.9 GM/DL
TLC-7,900 CELLS/CUMM
NEUTROPHILS-80%
LYMPHOCYTES-13%
PCV - 31.7 VOL%
RBC -3.79 MILLIONS/CUMM
PLT- 3.27 LAKHS/CUMM
Treatment Given:-
1.SYP.ASCORIL LS 10 ML PO/TID X 5 DAYS
2.TAB.AGUMENTIN 625 MG PO/BD X 3 DAYS
3.TAB AZITHROMYCIN 500 MG PO/OD X 3DAYS
4.TAB.ZORYL MV1 PO/OD
5.TAB.PAN 40 MG PO/OD X 5 DAYS
6.TAB.DOLO 650 MG PO/SOS
7.TAB.ISONIAZIDE 225 MG PO/OD X 3 DAYS
8.TAB.RIFAMPICIN 450MG PO/OD X 3 DAYS
9.TAB. PYRAZINAMIDE 1125 MG PO/OD X 3 DAYS
10.TAB.ETHAMBUTOL 675 MG PO/OD X 3 DAYS
11.TAB. PYRIDOXINE 40 MG PO/OD
12. 2 EGG WHITES / DAY
Advice at Discharge:-
1.TAB.ISONIAZIDE 225 MG PO/OD
2.TAB.RIFAMPICIN 450MG PO/OD
3.TAB. PYRAZINAMIDE 1125 MG PO/OD
4.TAB.ETHAMBUTOL 675 MG PO/OD
5.TAB. PYRIDOXINE 40 MG PO/OD
6.TAB. ZORYL- MV 1 PO/OD
7.TAB. DOLO 650 MG PO/SOS
8.SYP. ASCORIL D 10 ML PO/TID
9. 2 EGG WHITES / DAY.
