Concluded Case

Case of Tuberculosis

A 76 year old patient with history of multiple CVA completely bedridden and on ryles tube feeding since 5 years presented with progressive cough since 4 months. He was admitted to ICU following episodes of hemoptysis ( ~100ml, clotted as well as fresh blood) . CXR was suggestive of tuberculosis and confirmed by HRCT and CB-NAAT. The patient was started on IV ceftriaxone and ATT in hospital and improved significantly. After a few weeks from discharge he again had cough and mild hemoptysis. Is there any other findings in the CXR? any evidence of chronic aspirations since he is being ryles tube fed? Any cardiac abnormalities? Recently after a month of starting ATT, the patient has multiple episodes of Vomiting/ hiccups after every feeding. Metoclopramide, domperidone, ondansetron has been tried without much success. At present ( four months since) the patient has Cheyne stoke breathing pattern more prominently in left lateral decubitus. Since the period of start of hemoptysis to recent, there is gradual decrease in cognitive responsiveness.

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Concluded answer
Pulmonary koch,s with superadded infection Brain cerebral atrophy
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Ct brain shows old left parietal infarction,periventricular hypodensity,cortical atrophy with compensatory dialatation of 3 rd and lateral ventricles. The Ct picture is suggestive of old infart,cerebral small vessel disease of brain with age related cortical atrophy. Check for serum electrolytes for drowsiness
Bil ground glass opacities with reticulonoduler opacities and rounded calcified lesions seen. Findings sugg of PTB sequelae. Evaluate for malignancy in association.
Cb naat is positive. Blood parameters are within normal range. Is evaluation for malignancy required then also?
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Pulmonary koch,s with superadded infection Brain cerebral atrophy
Thank you doctor
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आयुर्वेद में इसे राजयक्षमा कहते हैं। चिकित्सा संबंधी योग,,,, बसंत मालती रस स्वर्ण युक्त 1 रत्ती सत गिलोय 4 रत्ती खर्पर भस्म 4 रत्ती रुदन्ती चूर्ण 2 ग्राम शहद में मिलाकर सुबह-शाम सेवन कराएं। कनकासव द्राक्षासव दोनों को मिलाकर 25 ग्राम सुबह-शाम खाने के बाद दें। योग परिक्षित है। पिछले 40 वर्ष से प्रयोग कर रहा हूं।
Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!
Old fibrosed cavities or R/o CA lungs also