CASE PRESENTATION

Supervisor: Dr. Kamarul Ariffin

 Mr M/ 54yo/ Male
History of PTB in 2008, completed treatment
Works in a stall
Active smoker ~ 35 pack years
ADL independent, NYHA class I

 Initially brought in by employer as noted pt

tachypnoiec, however pt claim hes comfortable
Claim had productive cough x 2/52
Whitish sputum
Hemoptysis several times : blood streaked in sputum
Pleuritic chest pain

Associated with:
On and off SOB, aggravated by vigorous coughing
Night sweats
Good appetite but claim had loss of weight (change in
trouser size)

No fever
No PTB contact

 In ED, noted SPO2 on arrival 89% under room air,

pick up to 98% under NPO2
Noted coarse crepts at right mid to lower zone

FBC: 4.7/ 9.5/ 31/ 30

CXR impression at ED: bullae at right LZ + fibrotic
right lung + deviation of trachea to the right side
Impression
Right pneumonia TRO PTB reactivation with pancytopenia

Pt admitted to W1

Plan:

Started on IV Augmentin 1.2gm stat then TDS

T EES 800mg BD
Hemoptysis chart
KIV Mantoux
Blood ix taken: FBC, coagulation, RP, LFT, ESR, FBP
For sputum C+S and AFB
Daily FBC
For PR: brownish

RP: 135/ 3.3/ 1.7/ 50

Corr Ca: 2.13/ Mg 0.85/ PO4 1.08
LFT: TP 72/ alb 35/ TB 8.9/ ALP 70/ ALT 8/ AST 11
LDH 231
ESR 57
Coag: pT 12/ apTT 34.9/ INR 1.14

 Seen by specialist (1/11/14)

CXR noted: ? Lung lesion sent for reporting
Sputum AFB x1: no AFB seen
Impression:
CAP TRO PTB
Pancytopenia for Ix
Plan:
To trace FBP
For pt to wear mask
KIV CT Thorax after review CXR reporting

 Pt claim still having blood streak in sputum, cough

reducing
Noted sputum AFB no.2: AFB +2
FBP, CXR reporting: pending
Sputum C+S: NG
Sputum AFB no.1, 3: no AFB
Plan:
t/o W10
For TB notification
To start T Forecox III/III CM

 Right upper lobe

cicatrisation
(fibrotic collapse)
Right lung
bronchiectasis
Right
hydropneumothora
x

 Treat as relapse PTB

Started T Forecox III/III OD
IM Streptomicin 800mg OD
T Pyridoxine 10mg OD

FBP will be available CM (requested urgent)