Concluded Case

Pneumothorax in XDR TB

56/M chronic smoker with h/o taking att since 6 months with injectables in first 2 months brought to casualty with h/o exacerbation x 3days in type 2 Respiratory failure impending arrest Intubated. Cxr revealed right pneumothorax treated with ICD with trocar Patient improved with rx and excubated on day 2 Pipzo started when ET aspirate culture revealed pseudomonas Tapered off ionotrops on day 3 and shifted to ward with O2 @2L/min Patient himself revealed he was sent to a city far away for special tb tablets On requesting for details upteen times they brought it Patient was refered to Nodal TB centre for further management of XDR TB sensitive only to moxiflox and Linezolid on Bedaquiline regimen Moral of the story- no history is better than patients own history and no parient history is better than documented history

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When a pt with oldTB is put on MLB regime, it is considered MDR TB rather than XDR TB.From the the infmn supplied,I infer that the pt is a defaulter.THe hyperinflated chest due to bullae rupture results in tension pnuemothorax which presentented as clinically observed.This pt will be a regular visitor in a hospital if he defaults.I am ready for any correction if pointed out.
Yes sir thats the lekely etiology for the 2ndry spontaneous pneumothorax Regarding tb kindly look at the last image (top left corner) for the drug sensitivity test result He was not a defaulter (its not mandatory) The treating Medical officer from his village was probably smart to think of drug resistance when he was not responding to conventional regimen(details not availabe) Note- he is from a village approx 150kmz from the teritiary institute i work in and another 230kmz away from the nodal tb institute he was started on xdr regimen (not a regular visitor)
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Another moral of story is That dr antony is very active and hard working Congrates for saving life of some one
Thank you doctor
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Very nicely done Dr Antony.... Life of patient saved Start treatment for MDR TB
Thank you doctor
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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!