50 female cough dyspnea since 3 months not asso with fever anorexia.not responding to antibiotics ,bronchodilators and other symptomatic treatment. pt is non DM non HTN. plz interpret and sugg treatment.

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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
Thanx dr Shital Jadhav
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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 .
Thanks sir,HRCT is advised. Plan for asp Fum specific IGE.
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Sorry sir,not able to reply to the above post...some technical issues. Itraconazole and voriconazole have same lung penetration ....can be given sir ....
Thanks sir, for your valuable comments
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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).
Thank you doctor
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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.
Thank you doctor
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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
Thank you doctor
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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
Thanks sir, absolute eosinophillic count is 220. Does itraconazole have any role considering cost of voriconazole?
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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
Thank you doctor
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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.
Thanks sir,histoglibin therapy is given but clinically no improvement seen.
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Stop all the medicine. Only patient nebulized with in two hrs.from Diolin ; Google; Musinac.....Medicine only Allegra- m ; paracetamol should be given.
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