Case of the day

Erythema nodosum under Ix

Erythema.nodosum due to Tuberculosis/Sarcoidosis under Ix. Chief Complaints A 22 yr old female attended Mopd with Pain in small joints of hand and leg since 1 month with fever for 3 days. No associated rigor,cough,SOB,chest pain,loose stool,Vomiting, dysuria,headache,pain abdomen etc. She had similar H/O small joint pain in 2015 and was undiagnosed. No H/O HTN,DM,Thyroid disorder or Substance Abuse. Normal Menstrual cycle. Vitals stable except raised Temp. General and Systemic Examination WNL. Pt was admitted and routine Ix was advised. All her reports are normal except positive for Dengue IgM. After 7 days of treatment pt was still febrile even after adding Inj Artesunate when pt didn't respond after Prophylactic Antibiotic. Pt developed red colored macular patches over lower limbs and forearm likely to be Erythema.nodosum. Dermatology opinion was taken. Also her CXR demonstrated widened Mediastinum. Mantoux test along with CT Thorax and Abdomen was advised along with Sr Calcium and Sr ACE level. Her Mantoux test is positive with CT showing multiple pretracheal ,precarinal, paratracheal ,Tracheoesophageal groove,retroperitoneal lymphadenopathy. Sr Ca level is normal along with normal Sr Albumin. Her ACE level and other reports are awaited. Wt based ATT has been started with normal baseline LFT D/D Tuberculosis/Sarcoidosis.




Clinicopathological evaluation... TB test.. RT-PCR.. Covid 19... Cholelithiasis... Lymphadenopathy... Koch's test with... Treatment hospitality management under Covid 19 protocol....

Thanks doctor..


Mediastinal lymphadenopathy and mantoux test positivity may not be sufficient enough to start antituberculosis treatment Mediastinoscopy with lymph node biopsy can be considered for confirming the diagnosis

Wide mediastinum weight loss, lymphadenopathy in chest and abdomen, erythema nodusum, fever all suggest for tuberculosis, TB gold test must in this case Sarcoidosis is less possible Wait for ACE, after that ATT start

Positive tuberculin Normal s. Calcium.. Pointers against Sarcoid. Sug. Ct or usg guided fnac.. from intra abdominal lymph nodes.. For cytology.. Zn smears.. and CBNAAT TB IGRA... blood in heparin tube

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Pl go for tb gene test. It can be an auto immune disease. Pl get her Rheumatoid factor.Anti phoshpolipid antibodies. It could be tuberculous/autoimmune disease

GB stone and tuberculosis ATT and surgical procedure for GB stone ATT Levofloxacin OD Dolo 650 SOS Udiliv 300BD Multi vitamin OD Vitamin D 3 60 k weekly Pantaprazole OD Levocetrizine OD Plenty of liquid and ORS Rest

Pt has retroperitoneal lymph nodes & also chest nodes & mesenteric too with + ve TT ,so koch' most likely , sarcoidosis less likely as TT+ve ,ca normal , only thing u have to keep in mind is retroperitoneal lymph nodes & mediastinal , this can suggest NHL ,go for HIV testing also.association of lymphoma & tb is known & NHL.

Koch’s chest Erythema nodosum Cholelithiasis Ad TB Gold test R/o COVID by RT PCR Ref to surgeon

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