LEARNING MODULE TITLE
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Transcript of LEARNING MODULE TITLE
LEARNING MODULE TITLESUBTITLE
HISTORY OF PRESENT ILLNESS
An 18 year-old woman with no past medical history and no known risks for TB presents with several months of cough, weight loss, and fatigue.
• She had no underlying medical problems• No known contacts with MDR-TB patients.
INITIAL CXR
DIAGNOSIS
• She was determined to be at risk for TB based on her symptoms and underwent testing.
• Her sputum was found to be smear positive with 3+ AFB.
CLINICAL COURSE
• Two months after starting therapy, the patient had worsening shortness of breath and cough. – She was compliant with her TB treatment.
• She came to the hospital and had sputum that was smear + and an CXR that showed the following findings.
The CXR showed a collapsed left lung. The patient underwent a bronchoscopy to visualize the airway to determine the problem in the left lung.
FOLLOW-UP CXR
Bronchoscopy showed tuberculosis at the end of the airway (endobronchial TB) in the left airway. The patient underwent dilation of the airway and was continued on first-line drugs.
BRONCHOSCOPY
CLINICAL COURSE
• The patient continued her first line drug regimen with good adherence and compliance
• After 5 months on therapy, her sputum smear remained positive (1+/2+).
• Sputum culture and drug susceptibility testing showed resistance to INH and Rifampicin, meeting the diagnosis for MDR-TB.
MDR-TB DIAGNOSIS
• The patient was switched to second-line drugs for MDR regimen, and she has steadily improved while on treatment.
• Her last CXR was ***• Her last sputum smear/culture was ***• She has *** months left on treatment
TEACHING POINTS
• What are the classic risk factors for MDR-TB?• In patients without these classic risk factors,
when would you think of testing for MDR-TB?• What are the symptoms and signs of collapsed
lobes of the lung?• What is the treatment and follow-up for
endobronchial TB?