LAMPIRAN 1 SULIT

Chronology of ilnesses as below;

2014- Developed GERD with Large Hiatus Hernia. Planned for fundoplication, sent to Gastro
HKL for manometry study, noted incidentally having Esophageal Dysmotility Disorder-
Distal Esophageal Spasm (DES). Last manometry study done at HUKM in May 2022
confirmed DES.
2015- Developed Dyslipidemia and T2DM.
2016- Started having B symptoms of malignancy, low back pain, lethargy and peripheral
small joints pain. Investigated extensively under Rheumatology Hosp Seremban with
presumptive diagnosis of Fibromyalgia
June 2016- Managed to enter Masters in Nuclear Medicine program under USM, had severe
chest pain in Oct 2016, CECT showed anterior mediastinal mass.
Started tx with Chemo and Radiotherapy until Feb 2017. Re-entered into the program but was
frequently admitted to hospitals. Decided to quit the program without any penalty.
Started working at PKD Titiwangsa in 2018 until now.
On prolonged MC and in the process of establishing a Medical Board.
Details of illnesses with medications and follow up centres are as below:

✓Type 2 Dm with Neuropathy (Under Endocrine HKL)

T.Vildagliptin 50mg bd
C.Pregabalin 300mg bd
Insulin Ryzodeg (Degludec 70%, Aspart 30%) 68 units pre dinner
Insulin Novorapid 20 units pre or post breakfast and lunch

✓Dyslipidemia (Under Endocrine HKL)

T.Rosuvastatin 30mg on
T.Ezetimibe 10mg on

✓Reactivation of Pulmonary Tuberculosis -based on clinical diagnosis (Sputum Smear and

Culture Negative, Left upper lobe lung biopsy of subcentimetre consolidation on HPE
showed Chronic Granulomatous Changes.- Based on PETCT scan findings.
(Under IPR Dr Zamzurina)- Started with Akurit 4, unable to tolerate, rechallenged with each
drugs slowly, omitted Ethambutol from the regime. Completed intensive treatment consisting
of Rifampicin, Isoniazid and Pyrazinamide for 2mths from June 2022, thereafter with
Rifampicin and Isoniazid until end of May 2022.
Initially had good response mid treatment, later had poor response to treatment. Meanwhile, 3
sputum cultures grew NTM, Mycobacterium Fortuitum and Chelonae Complex -MFCC

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Rifampicin 400mg od
Isoniazid 300mg od.
Pyridoxine 50mg
Kytril 1mg on
Buscopan 1tab tds
Above is the tx for Reactivation of PTB
Having poor tx response and relapse of symptoms (copious phlegm, fever, night sweats,
SOB& lethargy) mid tx around November 2021.
Cased discussed in Multidisciplinary Meeting, included among others, Pulmonologist,
Neurologist, Gastroenterologist (Prof Raja Affendi) and Pain Specialist Hosp Selayang.
Decided to treat NTM. Choice of drugs was roughly told in the clinic prior to admission ie
mulitple abx including Aminoglycosides and Macrolides. The risks of Myasthenic Crisis
were also told and Neuromedical Hkl for backup.
Admitted to IPR on 16/05/2022. Azithromycin was started 1 st, then Ciprofloxacin, and
Imipenem as the 3rd drug. Later was told another 2 drugs to be given were Linezolid and
Clofazimine.
Not keen on taking both Linezolid due to its permanent neurotoxicity and peripheral neuronal
axonapathy issues and Clofazimine with skin discoloration leading to most patients having
depression on top of its fatal GI side effects. Due to refusal of these 2 drugs, it was agreed to
continue on only 3 drugs ie Azithro, Cipro and Imipenem, Planned for bronchoscopy on 24 th
of May 2022.
Post bronchoscopy, I was in HDU IPR, developed exacerbation of MG without crisis,
planned for Icu/Hdw HKL admission, no bed vacancy in both units. Finally was warded in
acute medical ward 18B.
Had issues with poor care especially with drugs not being served only until 3pm and
communication failures between IPR, Neuromedical and Medical ward staffs on handling this
issue. Initially requested for AOR discharge to private hosp since being in the ward without
proper medical care would pose a greater risk plus the unavailability of Icu beds. Conditions
finally improved and Neuromedical and IPR decided to discharge me on 25 th May 2022. Next
TCA IPR on 16/06/2022.

✓Bronchial Asthma  (Under IPR Dr Zamzurina)

MDI Salbutamol 2puffs prn
MDI Foster 2 actuations bd

✓Hx of Diffuse Large B Cell Non-Hodgkin's Lymphoma Stage 2B (Primary Mediastinal

Bulky Mass)- (Under HUKM Prof Rafeah/Dr Siva currently)

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Completed Chemo and Radiotherapy in Feb 2017 at Pantai Hospital Bangsar KL (Under Dr
Vijaya Sangkar)
Radiotherapy to the chest, 40 Gray each for 20 fractions
Pet-Ct scan in May 2021, in IKN showed left suncentimeter lung nodules ; and consolidation
with air bronchogram with a highest SUV uptake of Deauville 5 category.
Lung biopsy of the consolidation taken at HKL ordered by IPR. HPE showed chronic
granulomatous changes. Given a clinical diagnosis of smear negative,culture negative PTB
by IPR.
Latest Pet-Ct scan at IKN on  11 Feb  2022 showed stable FDG avid lung consolidation with
no evidence of FDG avid lymphomatous activity seen elsewhere.

✓Chronic Musculoskeletal, Neuropathic and Low Back Pain (Under Pain Clinic Hosp
Selayang)
T.Targin 10/5mg bd
C.Nortriptyline 30mg on
T.PCM 1 g tds/prn

✓Osteoporosis of the Spine and Hips (Under Rheumatology HKL)

T. Calcium Carbonate 500mg od
C. Calcitriol 25mcg od

✓Inappropriate Sinus Tachycardia Syndrome

(Initially under IJN, discharged from IJN to continue Ivabradine under  Cardiology HKL)
T. Ivabradine 5 mg bd

✓ Prolapsed Intervertebral Discs, Lumbosacral arthropathies and Left Sacroilitis

(Under Orthopedic Surgeon and Interventional Pain Specialist Dr Ozlan Gleneagles )
Had Pulsed Radio-frequency tx and epidural steroid injections done multiple times 
Latest MRI of Lumbar and Pelvis regions showed
~Type 2 Modic endplate changes noted at L3/L4 and L4/L5 levels with partial disc
dessication at L4/L5 level
~At L4/L5 level , disc bulge noted with mild spinal canal and mild bilateral exit foraminal
narrowing
~Chronic Left Sacroilitis with fatty metaplasia changes over the superior aspects of both Left
Sacral and Iliac regions

✓Left Ilioinguinal and Iliohypogastric nerve entrapment (Under Orthopedic Surgeon and

Interventional Pain Specialist Dr Ozlan Gleneagles KL)
Steroids and prolotherapy injections done a few times

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✓Hiatus Hernia Grade 4, Chronic Gastritis, GERD and Esophageal Dysmotility

Disorder (Distal Esophageal Spasm)- ( Under Gastroenterologist and Hepatologist Dr
Hamizah Razlan KPJ Ampang Puteri and HKL Gastro)
T.Vonoprazan(Vocinti) 20 mg od
T.Pinaverium bromide(Dicetel) 100 mg tds
C.Meteospasmyl 1 cap tds

✓Hx of Smear Negative,Culture positive Pulmonary TB (Under IPR Dr Zamzurina)

Dx on 18/09/19
Completed treatment on 22/03/20

✓Myasthenia Gravis (Under Neuromedical HKL)

T.Prednisolone 10mg od
T.Pyridostigmine 60mg tds

✓Crohn's Disease of the small bowel- early stage (Diagnosed by Prof Raja Affendi
HUKM)-follow ups prn at HUKM. (Under Gastro HKL as well)

✓Chronic rhinosinusitis (Under IPR Dr Zamzurina)

T.Montelukast 10mg on
T.Loratadine 10mg on
Mometasone Nasal Spray 1 actuation each nostril on

✓Proteinuria 2ndary to T2DM (Under Endocrine HKL)

T.Perindopril 2 mg od

✓Hx of Covid infection on 15th of March 2022: completed HSO, Cat 2A

Current issues
1. Persistent daily low grade fever, mainly in the evening and at night.
2. Profuse sweating especially at night.
3. Headache- usually occurs at night together with fever.
4. Left lower quadrant abdominal discomfort.
5. Left inguinal and left testicular pain.
6. Lethargy.
7. Recurrent infections especially UTI and oropharyngeal candidiasis.
8. Occasional proximal muscles weakness, resolves after a period of rest or increasing
steroid/pyridostigmine dosage.