Esr 109mm and IgE more than 11000 xray chest shows nodular swellings and haziness lt lower zone this suggests she is long standing c/o allergic bronchitis recieved sec infection as lt base suggest on xray. D/d pneumonitis CAP Mycoplasma or klebsila Rx cefixim+Lenizolinid 1bd +tab itracanazole200mg 1od and tab fexofendine180mg 1od at bed time and tab monteleukast10mg for pretty long time with monitoring add rotacaps for dysponea
Nice case sir . A case pulmonary infiltrate with eosinophilia. First of all need to know ,is patient asthmatic and is it controlled or not . This is because to rule out ABPA . Need to get hrct thorax and serum IgE specific to Aspergillus fumigatus. Also need to rule out hyper IgE and IgE myeloma because per the provided information eosinophils are normal but very much raised level of S. IgE .
Sorry sir,not able to reply to the above post...some technical issues. Itraconazole and voriconazole have same lung penetration ....can be given sir ....
1. Raised ESR above 100 with very high IgE, Dyspnoea, Cough......? ABPA IN AN ASTHMATIC. 2. Gram positive cocci in chain.... Possibly STREPTOCOCCAL INFECTION. 3. Other possibilities are Pulmonary TB (raised ESR, cough, Xray shows lt lower lung opacity), IgE myeloma (normal eosinophil, very high ESR). Advice.... 1. HRCT Thorax 2. Aspergillus specific serum IgE and IgG 3. Sputum for CBNAAT 4. Until diagnosis is made treat asthma with LABA, Inhaled corticosteroids, Monteleukast levocetirizine. Give antibiotic to cover streptococcal infection(Penicillin G or Aminopenicillin or 1st /2nd Gen Cephalosporin).
Serum IgE is more than 11000,ESR raised 110. X-ray hyperinflated lungs with diffuse nodular infiltration with parahilar lymph nodes calcification. Investigation: Specific IgE estimation to aspergillus fumigatus, CBNAAT. HRCT of Thorax. Blood for CS. Add Inj Meropenem 1 gm IV BD, others to continue.
IgE raised 11000, esr 109, CXR shows nodular swelling and haziness lt lower zone. Eosinophils normal. Is patient Asthmatic?? Investigation: HRCT chest for cystic fibrosis, Aspergillus IgG antibodies for ABPA If ABPA, then itraconazole 200mg bd for 4 months, glucocorticoids
IgE and IgG specific to aspergillus fumigatus and absolute eosinophil count. We usually give prednisolone 0.5mg/kg/day in tapering doses along with voriconazole for 3 months with monitoring of IgE levels which usually falls by 50% in 2 months
Sir, we consider as a case of Allergic Asthma Symptomatically following drugs can be, Tab--Seretra 80mg od Tab--Odimontfx.(fexofndn,montlucst) od Tab-Syskan150mg Fluticasone+solmetrol--Inhaler Possiblyity of CA can be investigated
I agree with Dr.Shivraj , Inj.Histaglobin weekly once for one month, monthly twice for two months and monthly once for four months will be much beneficial.
Stop all the medicine. Only patient nebulized with in two hrs.from Diolin ; Google; Musinac.....Medicine only Allegra- m ; paracetamol should be given.
Cases that would interest you
- Login to View the image
A pto 24yrs having c/o lethargy 2 months. no h/o fever cough ,chest pain. he was unfit for medical check up for a broad. he is working as aluminium cutter for 3years. please discuss the x ray.Dr. Farooq Mohd9 Likes31 Answers
- Login to View the image
55 nonsmoker male presented with dry cough dyspnea since a year.not associated with fever anorexia etc. farmer by occupation. no clear past h O, PTB BP130/80 SPO2 86%,HR120. on formeterol budesonide combination. left supraclvicular breath sounds reduced. plz discuss and guide.Dr. Sandeep Ghodekar12 Likes35 Answers
- Login to View the image
Friends today I am discussing about a very serious problem most of the peoples have on change of weather. As weather is changing in these days here value of the content is important. Topic is Allergic bronchitis. Bronchitis is an inflammation in the lining of the bronchial tubes. These tubes in the lung carry air into the lungs from the mouth and nose. The swelling narrows the airway causing a cough and may make breathing more difficult. The irritation can also lead to increased production of mucus, which blocks the airway. Bronchitis can be classified as either allergic, non-allergic, or asthmatic, depending on its cause. Although the symptoms of bronchitis are similar regardless of the cause, there may also be differences, especially in how long a person will feel the effects of the condition. What is allergic bronchitis? Allergic bronchitis Allergic bronchitis occurs when an allergen inflamed the lining of the bronchial tubes. Allergic bronchitis involves inflammation of the bronchi caused by an allergen, or something to which you are allergic. Airway irritants, such as pollen, dust, and mold, can trigger symptoms. Cigarette smoking almost always causes allergic bronchitis. The symptoms of allergic bronchitis may last for a long time or keep recurring. Allergic bronchitis that lasts longer than three months is often called chronic bronchitis. This is a type of chronic obstructive pulmonary disease (COPD). Chronic bronchitis is almost always caused by cigarette smoking. Symptoms of allergic bronchitis include: a cough that produces mucus wheezing chest tightness tiredness Bronchitis can also lead to complications. For example, lung infection, such as pneumonia, can occur. In the most severe cases, pneumonia can lead to an infection in the bloodstream called septicemia. Septicemia is often life-threatening. Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD) Click here to learn more about COPD. READ NOW Non-allergic bronchitis Non-allergic bronchitis occurs because of a viral or bacterial infection. For example, some people develop non-allergic bronchitis after a cold. Although anyone can develop non-allergic bronchitis, older adults have a higher risk of experiencing the condition. People with weakened immune systems and those who smoke also have a higher chance of developing bronchitis after an upper airway infection. Symptoms often improve within a few weeks and are less likely to recur than the symptoms of allergic bronchitis. Non-allergic bronchitis is sometimes called acute bronchitis, as symptoms may onset suddenly and are typically brief. Symptoms of non-allergic bronchitis might include: a cough that produces mucus chills fever What is asthmatic bronchitis? Asthmatic bronchitis Asthmatic bronchitis can occur in people who already have asthma as an underlying condition. Like bronchitis, asthma is a lung condition that can cause breathing difficulties. Asthma can also cause inflammation of the bronchi, but can also lead to narrowing of the muscles around the airways. When bronchitis and asthma occur together, and symptoms overlap, the condition is often known as asthmatic bronchitis. Inflammation that triggers symptoms of asthmatic bronchitis might occur in someone who has underlying asthma after exposure to certain substances, such as pollen, pollution, and cigarette smoke. Some people also develop asthmatic bronchitis because of a change in weather or exercise routine. People with asthmatic bronchitis respond to these environmental triggers by releasing leukotrienes. These are inflammatory molecules. Leukotrienes cause a series of reactions, including narrowing of the airway. Symptoms of asthmatic bronchitis may include: coughing excess mucus production wheezing shortness of breath Diagnosis A doctor will diagnose allergic bronchitis based on several factors. They will review the medical history of the individual with suspected allergic bronchitis, as well as perform a physical exam, usually ask questions to determine how long symptoms have been occurring. The physician may use a chest X-ray to rule out some other causes of breathing problems, such as pneumonia. They may also request blood tests to help determine if an infection is present. The patient may also receive a pulmonary function test. This involves the individual blowing into a special device called a spirometer. The device measures how much air a person can exhale, and how quickly. The test helps doctors to identify the presence of lung diseases, such as asthma and chronic bronchitis. Treatment Treatments for allergic and asthmatic bronchitis are often similar and may include the following: Bronchodilators Bronchodilators are medications that relax the muscles around the airways. As the muscles relax, the airways dilate or widen, often making breathing easier. People take bronchodilators through a metered dose inhaler. Both short-acting and long-acting bronchodilators are available. Short-acting bronchodilators act quickly to decrease symptoms, but the effects do not last. Long-acting bronchodilators do not reduce symptoms as quickly but control symptoms for a longer period. Steroids Steroids may also be used to treat allergic bronchitis. Steroids decrease inflammation in the bronchi. This action reduces coughing and may help air-flow in the lungs. Although steroids can be an intravenous or oral medication, a physician will often administer them through an inhaler in cases of bronchitis. This allows for quicker and more effective delivery of the drugs to the area that requires treatment. Mucolytics A mucolytic drug is a medication that makes the mucus thinner and less sticky. This making it easier to expel mucus from the lungs by coughing. People can take mucolytics either orally or through a nebulizer. A nebulizer is a device that changes a liquid medication into an aerosol. A person can then inhale this aerosol. Oxygen therapy In some instances, allergic bronchitis can interfere with the efficiency of oxygen flow into and out of the lungs. People with severe allergic bronchitis may have decreased levels of oxygen in the blood. If oxygen levels are low, a doctor may prescribe oxygen therapy. This can help restore oxygen levels to normal. Pulmonary rehabilitation classes People with chronic allergic bronchitis may benefit from pulmonary rehabilitation classes. Pulmonary rehabilitation classes involve supervised exercise, along with education on how to breathe better and manage allergic bronchitis. These classes show people how to decrease exposure to allergens that may trigger symptoms. Acute non-allergic bronchitis often does not require treatment. Doctors treat asthmatic bronchitis in a similar way to allergic bronchitis, with bronchodilators, steroids, and oxygen as needed. However, acute non-allergic bronchitis may also be treated with antibiotics if caused by a bacterial infection, though this is uncommon. In some cases, a doctor may also prescribe leukotriene modifiers to treat asthmatic bronchitis. These work by interfering with the chemical reactions that cause the symptoms of asthmatic bronchitis. Home remedies humidifier A humidifier can moisten the air and loosen mucus. Many of the treatments for allergic bronchitis require a prescription. However, there are also steps a person can take at home to reduce the effects of bronchitis. Although home remedies will not cure the underlying cause of allergic bronchitis, they may help to reduce symptoms. These steps including: Using a humidifier: A humidifier will moisten the air. This can loosen mucus and make it easier to expel. It may also decrease wheezing. People with asthma should check with their doctor before using a humidifier. Drinking plenty of fluids: Drinking enough water may help keep mucus thin. Gargling with salt water: The coughing from allergic bronchitis can lead to a sore throat. Gargling with salt water might ease discomfort. Taking a cough drop: A cough drop may keep the throat moist and can provide relief from coughing. Click here to choose online from an excellent range of humidifiers with thousands of customer reviews. Prevention Preventing allergic bronchitis usually involves avoiding irritants, such as chemical fumes, dust, and air pollution. Prevention of asthmatic bronchitis includes both avoiding triggers and managing your underlying asthma according to the plan developed with your doctor. Cigarette smoke is one of the leading causes of allergic bronchitis, so quitting smoking, or not starting at all, is one of the best ways to prevent the condition. If outdoor allergens, including pollen or mold, tend to cause allergic bronchitis, wear a mask when carrying out yard work. This might also prevent symptoms. BEST HOMEOPATHIC MEDICINES FOR ALLERGY Arsenic alb - There is thin watery discharge from the nose with burning sensation, recurrent sneezing one after another with runny nose. Burning and tearing of eyes . There is puffiness around eyes, stuffy nose. The person has an asthmatic tendency with breathing difficulties, and oppression of chest which is generally worse when he lies down. On sitting with a forward bending posture makes the patient little comfort from his asthmatic problem. There is marked wheezing sound during asthmatic affection. The asthma is worse in wet cold weather. Besides that the constitutional symptoms of arsenic alb are anxiety, restlessness, prostration, burning sensation. The anxiety that is found in Arsenic alb is intermingled with fear. The other prominent symptoms are debility, exhaustion, restlessness, with nightly aggravation. Great exhaustion after a slightest exertion. Sulphur – There is itching with redness of eyes in allergic condition. The itching is followed by burning sensation and relieved by cold application. sulphur patient is always irritable, depressed, thin and weak, but good vappetite. He is having forgetful nature, difficulties in thinking. He has many good ideas but cannot implement it. Selfish type person, no regards for others. very lazy person, not cleanness, never look after about his dressing and clothing. Don’t like to take bath. Having of skin diseases always. The skin rashes itch a lot generally in night and warm atmosphere. The person has a feeling congestion or oppression of chest in asthmatic condition.– Natrum mur – Natrum mur is generally well indicated in case of allergic condition which gives the symptoms of more itching of nose, throat, ear with recurrent sneezing one after another. The characteristic discharge from the mucous membranes is watery or thick whitish, like the white of an egg.Natrum mur patient is very sensitive in nature. Every thing he/she takes into the heart. The person is irritable in nature and when in upset does not like any body’s present or giving of any consolation.Consolation aggravated the state of the mind - the melancholy, the tearfulness, sometimes brings on anger. The Natrum mur patient is extremely emotional. The whole nervous economy is in a state of fret (visible anxious like scratching finger on her skin in worry). Completely or desperately in love brings on complaints. The natrum mur patient desire to take extra salt in his diet. Sabadilla- it has good action on mucous membrane of the nose and the lachrymal glands, producing coryza and symptoms like hay-fever. There isspasmodic sneezing one after another. symptoms of hay-fever or allergic rhinitis with itchy nose and fluent coryza. Either nostril stuffed up, inspiration through nose labored, snoring. Violent sneezing is occurred from time to time, shaking abdomen followed by lachrymation. There is runny nose with severe frontal headache and redness of eyelids. Allium Cepa Allium Cepa is one of the most commonly used Homeopathic medicines for Allergic Rhinitis or Hay Fever. It is generally used in the symptoms of severe runny nose that drips from the tip of nose with watery eyes. There is burning of nose due to over secretion mucous. Along with the watery nasal discharge there is watery eye. There is profuse sneezing associated with runny nose and watery eyes. Tuberculinum- The patient is very susceptible to catch cold. The physical constitution is lean and thin like natrum mur, but not obese like calcarea carb. If there is family history of tuberculosis or bronchial asthma then is more suitable to give this medicines in any allergic or asthma condition. The person is very depressed, melancholic, taciturn sulky nature.Dr. Rajesh Gupta12 Likes18 Answers
- Login to View the image
### 35 years old lady presents to OPD with fever daily since last 6 years. Associated with rigor on and off. Associated with generalized weakness and loss of appetite. She looks ill. Took medications OTC and from doctors also but in vain. She even got IV antibiotics (Inj. Xone, as per her talks) but no improvement. Her MP Optimal is negative and her Widal test is also negative. Her WBC count is within normal limits. But her ESR is raised much. Her DLC is within normal limits in one report and in another report her Eosinophil count is raised, RBC count is decreased (but Hb normal) and PCV decreased slightly. RE Urine is also within normal limits. Her serum uric acid and RBS are also within normal limits. She also complains of passage of white discharge per vagina. Also she complains of dry cough. How to approach and manage this case ??? What might be the diagnosis ??? What further investigations should be recommended to arrive at the diagnosis for proper treatment of this case ???Dr. Shofique Anowar5 Likes14 Answers
- Login to View the image
26yr old female came to opd with c/o dyspnoea on exertion,nasal congestion,headache ear block off and on.H/o similar complaints last yr in same winter season. blood reports TLC 17000 eosinophils 55 '/. AEC 1300 O/E B/L wheeze (minimal) B/L turbinate hypertrophy. we came to a diagnosis of tropical pulmonary eosinophilia (TPE) treated patients with itracinazole 200 for 14days mometasone nasal spray and anti histamines. PT feels good now. ur expert comments on the case pls!!!Dr. Siddharth Ajay2 Likes13 Answers