13 y male,cough dyspnea,diagnosed Koch's pleural effusion.fluid drained,started 4 drugs AKT.now patient is having itching and nausea vomiting.LFT normal.serial cxrays and lab displayed.. what next?



Pleural effusion, tuberculosis,ETB. Lab results s/o tuberculosis. LFT normal, problem still C/O nausea & vomiting. Probably due to INH side effects. In my opinion some Prokinetics may help.Just try sir keeping 4 drugs.

Thanks sir, he is on rabeprazole+dom at present.

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Itching and nausea vomiting in a pt on att ,most common cause can be 1. Drug induced gastritis for vomiting 2. Att induced cholestasis with normal sgpt and sgot ,we must look for alkaline phosphate (ap)and ggt ,they can have isolated raised level ,then choice is to 1. Add ppi with domperidone 2. Withdraw the culprit drug and continue the regimen of two or one hepatotoxic drug at a time 3. Pruritus needs additional use of oral steroids which even will help in prevention of pleural adhesions 4. stop att till pt get relief from symptoms then restart with gradual increase in att doses

These are common events on ATT hence don't worry manage with iv fluids and ppis and antacids in due course that will be controlled if not at all possible that temporarily stop att first manage the episode and restart att.

Encysted costal pleural effusion right Drained by ICT,ATT administered. Resolved to thickened pleura. Presents symptoms may be hypersensitivity to administered drugs.

Thanks sir!

May be drug allergy, difficult to decide what to do. Try anti allergic and treatment for gastritis.

RT pleural effusion, as LFT isWNL, Maybe givenPPI with drugs.

If it doesn't improve with allegra, rabeprajole +domperidon by two weeks then stop all atd and start one drug at a time for one week and identify the culprit medicine and exclude it..Continue other medications for full duration.

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10 TU. tuberculin is not acceptable now Results are erretic and so 16 mm reaction is also sign of good resistance to Tuberculosis.

Common trivial s/e of ATT .Reassure d pt n wait upto 10to 15 dozes. Often subside usually .Adv pt. to take drgs with less water.

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