12 years female, since one year complaints of on off cough, family history of Koch positive, MANTEOUX NEGATIVE , NECK LYMPHADENITIS +++ , ESR 100 PBF AND BONE MARROW REPORT WILL DISCUSS AFTERWARDS dx ,dd,

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X- Chest Rt hilar lymphadenopathy+ Family h/o TB+ My concern is a/t CBC in which TLC 41600 with G 90% PBF & BM report awaited The investigation of choice here is lymphnode biopsy for HPE & CB NAAT test Plz update with remaining reports

Chronic cough H/O contact with tuberculosis TT -- negative ESR very high Cervical LAP WBC very high Thrmbocytosis Cxr --Rt hilar LAP Wide mediastinum DD ---kochs Lymphoma

Rt hilum enlarged Rt paratracheal glands positive Neck LAP Family history for tb positive So 1st. Tubercular 2nd Needs investigation for Lymphoma

Rt. prominent Hilum. LAP neck. Family history is also positive.so D)D Pulm. Koch's. Investigate for leukemia

CXR SHOWS : BILATERAL AIR BRONCHOGRAM+ MEDIASTINAL WIDENING + RIGHT PARACARDIAC OPACIFICATION + BOTH DOMES DIAGPHRM AT SAME LEVEL + DX : PULMONARY KOCH'S. D/D : LYMPHOMA. HODGKIN'S.

Rt parahilar and paratracheal lobulated opacity. Enlarged lymhnodes.Tubercular.

Counts are too high so trear with antibiotic for 14 days sputum with afb Then if no improvement then start att DD LYMPHOMA BUT HIGH COUNTS ARE NOT NI FAVOR OF ATT

Updated report of bone marrow Thanks to all of you for wonderful discussion More favour towards TB Started ATT

12 yr female Cough on and off 1 year Contact positive X ray corroborative Do sputum for AFB CB NAAT EXCISION biopsy Ideal candidate to start ATT

Xray chest suggestive, history of contact positive, gastric aspirate and induced sputum for afb, lymphnode exision biopsy, HPE and geneXpert on specimen.

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