Challenging question

22 year old boy came with complaints of hemoptysis and hematemesis since 2 years, History of pulmonary tb 2 years back took treatment for 3 months and left treatment, Repeated sputum test come negative, Recent sputum for AFB negative Kindly suggest management and diagnosis

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Hemoptysis and hematamesis simultaneously unlikely It could be swallowing of hemoptysis inducing vomiting seen of blood contents Past h/o pulmonary tuberculosis and leftout treatment I need to investigate in detail Adv xray chest and hrct Repeat sputum for AFB and cbnaat or TB gold test Also adv for endoscopy upper GI tract Monitor vitals Such a long history of hemoptysis or hematamesis still vitals are missing Adv cbc esr bsl urine

Thnks again for ur guidance sir His vitals are bp -110/80,pulse 98,spo2-98 He's clinically stable ,but complains of blood comes when he vomit ,blood comes when he cough Some local dr gave him amoxyclav blood stooped ,but as soon as he finish course of amoxyclav blood agains come I advised hrct and pt inr His recent sputum report 12 days back is negative , Cbnaat can't be done as technicians saying unless sputum is free of blood can't do cbnaat
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Do ct pulmonary angiography.and hrct chest After routine investigations.. And do inr too.. Genexpert tb.. Start tranexa bd Or tds.. May require repeat tb course if active.. Or may need bronchoscopic evaluation..

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