Discuss and Give furthur management

65 yr old male with a h/o MI 2 months back presented with breathlessness for 1 month admitted in Pulmonary ward with increasing breathlessness and cough with fever on/off. Patient is also on MI medications ( atorva, ecosprin etc). Currently patient is on high flow oxygen via face mask . Took ATT in 2016 for 9 months . Sputum genexpert - MTB not detected CECT chest ( films attached) Usg chest and abdomen attached Sputum AFB d/s - negative Chest x ray attached Pleural fluid reports attached.

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CT thorax and cxray shows bil diffuse parenchymal reticulonoduler infiltration with rt sided min pleural effusion. Findings sugg of ILD with pleuroparenchymal Koch's. Also Sugg to do cytology considering malignant cells.

Cytology shows no malignant cells. Can we start ATT in this case ??
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@Sandeep Ghodekar @Mayuri Johari Phadnis @K N Poddar

Agreed with views of Dr. Sandeep. Need to consider ILD. But can think of Tuberculosis as reactive case.

@Dr. Kunal Datta @Kanwarjit Kakkar Pulmonology

Pulm koch.s right plural effusion renal calculi UTI