Tuberculosis
Patient presentation:
J.S., a 36 year old female presents to the ED with complaints of cough times
2 weeks, and shortness of breath on exertion and fatigue. On the history you
find out that the cough is non-productive. She is experiencing loss of
appetite and has lost approximately 7 pounds over the last 2 weeks. During
the night she experiences fevers to the point that four times over the last
2 weeks she has needed to change her sheets due to sweating. Approximately 3
weeks ago she traveled to eastern Russia. Vitals are HR: 102, RR: 22, SaO2
96% Room Air, BP: 128/78, Temperature 38C.
Differential Diagnosis:
Pneumonia, Bronchitis, Tuberculosis
Labs:
- CBC: elevated WBC of 13.1
- CMP: normal
- Blood Cultures sent off
- Sputum Cultures (including AFB)
- PPD placed on left forearm to be read in 48-72 hours.
- Chest X-Ray shows a consolidation in the upper right lobe and hilar
enlargement.
Diagnosis/treatment:
Given the history of travel and all the symptoms this patient is presumed to
have Tuberculosis until it can be proven otherwise. She was sent to the
floor and placed in a negative pressure room. She was started on isoniazid,
rifampin and pyrazinamide for possible TB and Rocephin® for the possibility
of pneumonia. At 48 hours her PPD was positive at which time the Rocephin®
was discontinued and the sputum cultures were sent to the CDC to determine
if the strain of TB is resistant and if other medications are needed. Three
days after admission she was discharged home with instructions to take the
medications and have weekly follow up with public health to follow up with
medications and continuing sputum cultures until it is determined if more
antibiotics are needed. The predicted outcome is that she will take
medications for approximately 6 months and will recover well. She will need
to be educated on what to look for in the case of latent disease in the
future and how to best protect her family.