1 / 37

Case presentation 1

Case presentation 1. Dr REESAUL R. Case 1. Male 25 years old Ref on 06/04/2006 to poudre d`or hospital from private GP Cough hemoptysis and dyspnea. Case 1. He had several visits AHC and private doctors for cough since early childhood :

francisw
Télécharger la présentation

Case presentation 1

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case presentation1 Dr REESAUL R

  2. Case 1 • Male 25 years old Ref on 06/04/2006 to poudre d`or hospital from private GP • Cough hemoptysis and dyspnea

  3. Case 1 • He had several visits AHC and private doctors for cough since early childhood : ATB , cough mixture and discharge with diagnosis acute bronchitis • Since last 4 months severe cough and night fever he visited 4 AHC and twice casualty VH , each visits : ATB , cough mixture , PCM discharge home diagnosis acute bronchitis • Refer on 6/4/06 by private doctor to chest clinic

  4. Case 1 • Single • work in `pizza hut` since 5 years • Brother had TB 6 years back • Smokes 5 cig daily since 10 years • IVDA since 3 years • Alcohol on/off

  5. Case 1 • Examination : 1m74 ,52 kg cachexia weight loss 10kg/4 months • Temp 38.5 , productive cough, dyspnoea with orthopnea, mild haemoptysis and L chest pain • Crackles 2 lungs • Bp 120/80, pulse 120

  6. Case 1 • Spo2 : 87 % at rest • CXR (7/4/06): R + L opacities left effusion • ABG at rest : Po2: 59 mmhg, Pco2 : 34mmhg, Ph 7.39 • Tapping Left effusion 100 ml protein: 3.5g/l , glucose: 6.5mmol cytology : lymphocytes +++ no malignant cells • Sputum analysis

  7. CXR on admission 6/4/06

  8. Cytology report effusion

  9. Case 1 • Diagnosis young male-IVDA-bilateral DIL opacities U>L with exsudative effusion with lymphocytes hypoxia-hypocapnia • Atypical pneumonia or viral pneumonia? • Pleuro-pneumonia in IVDA? • Pulmonary tuberculosis with pleural TB? • Cystic fibrosis with chest infection involvement? • Pneumocystose Jirovecy immuno-suppression? • Pulmonary oedema with endocarditis in IVDA? • Systemic disease with lung involvement? • Malignancy with lung involvement? • PE?

  10. Case 1 • FbC N with ESR 40 , SGOT/SGPT raise • Mantoux test : 12mm • Blood culture : negative • Serology HIV : negative • Sputum : pseudomonas aeruginosa +++ • Sputum AFB direct : +++ • Sweat test normal at VH lab • Serology chlamydia and mycoplasma negative • ANF negative • ECG normal , Echo doppler cardiac normal • D-dimer negative

  11. Sputum result 12/4/06

  12. Blood test HIV

  13. Blood test FBC ESR

  14. Blood test LFT

  15. Positive findings AFB direct +++ Pseudomonas A +++ Exsudative lymphocytic effusion Mantoux 12mm other findings HIV negative Blood culture negative Serology mycoplasma chlamydia negative Sweat test normal ANF negative Cytology effusion no malignancy Echo Doppler cardiac normal D-dimer negative case1

  16. Case 1 • Diagnosis : pulmonary TB and with pseudomonas infection • Initiated on anti TB drugs : IRP and Ethambutol • IV ceftazidime 1g TDS + colistin neb 1mu bd + IV amikacin 750mg od • Solumedrol 40mg iv od • O2 : 3-4 l/m • IV fluids

  17. Case 1 • Clinical improvement on antibiotics and anti TB drugs • Day 6th sputum pathogen negative with still sputum direct AFB ++ • Final Diagnosis pulmonary TB • Antibiotics and steroids stop after 7 days • continuation of Anti TB drugs

  18. Case 1 • Day 10th severe skin rash with pruritis • ATT stop and initiated on anti-H1 and prednisone 40mg • Reintroduction pyrazinamid then ethambutol then rifampicin • On 50mg isoniazid pruritis and rash • Desensitization to isoniazid

  19. Case 1 • Day 30th : sudden onset dyspnea and R chest pain in ward • Temp 36 • BP 130/60 pulse 130 • Spo2 : 87% • Hypoventilation right lung • Possible diagnosis ? PNO- PE

  20. CXR Sudden dyspnea

  21. Case 1 • CXR : complete R pneumothorax • Chest drain inserted R side in surgical unit SSRN • 5th day complete re-expansion R chest and drain removed transfer back to poudre d`or hospital

  22. CXR insertion R chest drain

  23. CXR chest drain remove day 5

  24. Case 1 • Sputum month 1 AFB + • Sputum month 2 AFB + • Sputum month 3 AFB negative • CXR : improving • Discharge on IR and B6 follow up OPD chest Clinic • Culture sputum M tuberculosis sensitive to IRES

  25. Sputum result month 1

  26. Sputum result month 2

  27. Sputum result month 3

  28. CXRafter 6 month treatment

  29. Culture sputum

  30. Culture/Sensitivity results

  31. Case 1 • Regular follow up at chest clinic out patient • Off all respiratory symptoms • CXR improving • Sputum AFB negative • HR CT scan thorax cause PNO : emphysema causes : smoking Deficiency alpha anti- trypsin ? • Spirometry obstructive lung disease • Complete course of 6 months regiment anti Tb

  32. HR CT scan thorax

  33. HR CT scan thorax

  34. CRX after 1 year

  35. we have several thousands years of TB behind us………..still24th march 1905

  36. Thank you Merci

More Related