PULMONARY
TUBERCULOSIS
A CASE PRESENTATION
a
DR. VANESSA VALENCIA
PATIENT’S INFO:
A.B.
78 yrs old
Male
Married
Catholic
Arayat, Pampanga
C/C:
Cough
HISTORY:
2 weeks PTA, pt. experienced (+) cough,
nonproductive, accompanied by (+) loss
of appetite, (+) SOB, and (+) easy
fatigability, (-) fever  pt. only continued
his maintenance meds
1 day PTA, (+) persistence of cough, now with (+)
weight loss of about 8 kg (from 70 kg last
month to 62 kg)  admission
PMHx:
-
(+) Hypertension x 5 years
(-) DM
(+) Emphysema x 5 years
(+) Fatty liver
Meds:
 Febuxostat 40 mg tab OD
 Spironolactone 25 mg tab OD
 Felodipine 5 mg tab BID
 Liverprime cap BID
 Budesonide + Formoterol 80 mcg/4.5 mcg (Symbicort)
Rapihaler MDI 1 puff BID
 Combivent neb OD
FHx:
- (+) Lung CA, sister
- (+) Fungus Ball, brother, S/P removal 2 years
ago
- (+) PTB, oldest son
P/S Hx:
- (+) smoking x 46 years (46 pack years), stopped
15 years ago
- (+) alcohol beverage drinking, almost daily, 1-2
bottles of beer/day
- (+) exposure to a known case of PTB
- Retired budget officer in Arayat Municipal Hall
PE:
VS: BP – 140/80, HR – 90, RR – 21, Temp – 36.8°C, O2 sat – 95%
-
-
-
Conscious, coherent, not in respiratory distress,
Anicteric sclerae, pink palpebral conjunctivae, (-) nasoaural
discharge, (-) tonsillopharyngeal congestion, (-) CLADs
Adynamic precordium, normal rate and regular rhythm, (-)
murmurs
Symmetrical chest expansion, (-) retractions, (+) rales, (+)
rhonchi, (+) wheezes, BLF, L>R
Abd’n flabby, normoactive bowel sounds, (-) tympanism, soft,
non-tender, (-) mass
(-) edema, full and equal pulses
No neurodeficits
Salient Features:
-
78 yrs old, male
Cough
loss of appetite
SOB
easy fatigability
weight loss
(+) Hypertension
(+) Emphysema
(+) smoking
(+) PTB on oldest son
(+) exposure to a known case of PTB
(+) rales rhonchi wheezes, BLF
CBC
CHEMISTRY
Hct
0.46
0.42-0.48
SGOT/AST
29.84
14-59.00 U/L
Hgb
153
140-180 g/L
7.38
5-10.0x109/L
21.19
9-50.00 U/L
WBC
SGPT /
ALT
Neut
0.52
0.55-0.65
BUA
4.83
2.6-7.20 mg/dL
Lymph
0.33
0.35-0.45
Mono
0.09
0.00-0.05
Na
136
135-14 mmol/L
Eosino
0.06
0.00-0.01
K
4.32
3.5-5.3 mmol/L
PC
221
150-450x109/L
Crea
0.4-1.4 mg/dL
RBC
5.4
1.01
4.5-5.5
RBS
114.79
90-140 mg/dL
Serum
Albumin
3.5
3.5-5.0 g/dL
PSA
1.617 (NORMAL)
URINALYSIS
YELLOW
CLEAR
pH 5.0
0-1 pus cells
1-3 RBC
Bacteria:
Few
1.015
(-) glucose
(-) albumin
Impression:
Pulmonary Tuberculosis, Category I,
Clinically Diagnosed, New Case, with
Bronchiectasis;
Chronic Obstructive Pulmonary Disease
PLANS:
-
Admission
LSLF with SAP
Insert Heplock
Weigh pt daily
For 2D Echo with Doppler, FOBT, TFTs
Continue home meds
Increase Slabutamol + Ipratropium (Combivent) neb to q 8 hrs
For referral to Pulmoonology service:
 Start Rifampicin + Isoniazid + Pyrazinamide + Ethambutol
(Quadtab or Myrin-P Forte) tab 4 tabs 1 hr after breakfast
 Vitamin B complex tab 1 tab OD
 Continue Budesonide + Formoterol (Symbicort) Rapihaler MDI
80 mcg/4.5 mcg 2 puffs BID, gargle after use
 N-Acetylcysteine 600 mg tab OD
 Continue Combivent neb q 8 hrs
 For Sputum AFB x 2 collections, and Sputum GS/CS
PULMONARY
TUBERCULOSIS
DR. VANESSA VALENCIA
a
ETIOPATHOGENESIS
Caused by Mycobacterium tuberculosis
Most common site of development:
Lungs 85%
Transmitted via droplet nuclei
Most infectious: cavitary pulmonary disease and
laryngeal TB
Typical TB lesion is an epithelioid granuloma with
central caseation necrosis
MANIFESTATIONS
In the Philippines, cough of TWO WEEKS should
lead to a high index of suspicion for PTB
PRESUMPTIVE
2 weeks cough
Unexplained cough with close contact with a
known active TB (elderly, inmates)
Weight loss, fever, hemoptysis, chest and back
pains, night sweats
(+)gibbus
TB EXPOSURE
In close contact,
(-)signs and symptoms,
Negative TST reaction
No radiologic findings
TB infection OR
Latent TB
POSITIVE TST reaction
No s/sx
TB disease
Presumptive TB + clinically and diagnostically
confirmed
THANK YOU!