Case Tuberculosis and Mycobacterial pneumonia
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This 44-year-old male presented with progressive shortness of breath for one week. He had a history of weight loss, cough, and poor appetite. Physical examination revealed decreased skin turgor and crepitations on chest palpation. Chest X-ray and CT scan showed cavitary pulmonary tuberculosis with pneumothorax. Sputum tests were positive for Mycobacterium tuberculosis. The patient was diagnosed with pulmonary tuberculosis, acute respiratory failure, septic shock, and complications of pneumothorax and pneumomediastinum. He required intubation and mechanical ventilation in the intensive care unit.
Case Tuberculosis and Mycobacterial pneumonia
- 2. î}Ì– ÐÔ„e¡¢Äêýg Ö÷ Êö Ô\ ”à CASEÓЈDƬ£¬Õˆ ´ò¹´(V) ÊDZ¾ÈËÕÕ¬Õˆ´ò¹´(V) CASE 1. 41 y/o male; Dyspnea in 2 days. (V) ( ) Acute myopericarditis CASE 2. 44 y/o Male ; Suddenly onset abdominal pain (V) (V) Acute pancreatitis with acute respiratory failure CASE 3. 44 y/o male ; Progress shortness of breath for 1 week (V) (V) 1. Pulmonary tuberculosis with cavitation 2. Acute respiratory distress syndrome CASE 4. 66 y/o female ; general weakness for 5 days (V) (V) Hyponatremia CASE 5. 56 y/o female ; Fever up to 40¡¯C with chills for 1 day (V) ( ) Infective endocarditis of mitral valve, Staphylococcus aureus(MRSA) CASE 6. The 57-year-old female ; consciousness disturbance and fever for 1 day (V) ( ) Type II diabetes mellitus with hyperglycemic hyperosmolar state
- 3. Case 3 44 y/o male with progress shortness of breath for 1 week
- 4. CASE 3. ²¡ÀýÕªÒª Ö÷ÔV£º Progressive shortness of breath for 1 week º††Î²¡Ê·£º This 44-year-old divorced male has no systemic disease, according to his mother. This time, he was admitted for progress shortness of breath for 4 days. In recent one month, his mother mentioned that the patient had rapid body weight loss, cough, and poor appetite noted. In recent 4 days, the patient had progressive weakness and complained about throat soreness and general weakness. today the patient was found weakness and shortness of breath and was sent to ER. There is no fever, no chillness, no nausea and vomiting, no chest pain, no abdominal pain complained. At the ER, his vital signs were TPR 37.8/144/24 SpO2 97%. CXR and CT showed Active pulmonary TB with cavitation was suggested.And Small amount of pneumothorax and pneumomediastinum. subcutaneous emphysema at right chest wall and bilateral neck.For progress dyspnea and O2 desaturation, the patient was intubated. After for shock, levophed and hydration was given. Under the impression of TB and septic shock with multiple organ dysfunction, the patient was admitted to ICU for further care.
- 5. Chief Complain Progress shortness of breath for 1 week Past history Workman; Divorced Smoking (-) ; Alcohol (-) No medical history before; Allergy unknown TOCC (-) Patient
- 6. Patient illness Poor appetite Weight loss about 6Kg within 1 month Weakness and Bed-rest > 1 week RR PR BT SBP DBP 25 141 35 84 56 Con¡¯s alert, E4M6Vt Vital sign
- 7. Physical Examination Acute ill / Cachexia looking Decrease in skin turgor Crepitation on palpation over chest Chest: Bilateral Coarse Heart: Regular heart beat, No Murmur Abdomen: Flat Soft, Normoactive, No tenderness
- 11. ABG PH 7.475 PCO2 25.4 mmHg PO2 72.2 mmHg HCO3- 18.3 mmol/L BE -3.8 mmol/L O2Sat 95.7 % Lab data Bio Na 126 mmol/L K 5.6 mmol/L Bil-T. 0.9 mg/dL GOT 111 IU/L GPT 22 IU/L Ammonia 61 umol/L Glucose 118 mg/dL CPK 171 IU/L CK-MB 31 U/L Tn-T 13.2 ng/L Lactate 4.79 mmol/L BUN 45 mg/dL Cr 1.25 mg/dL CBC HGB 12.7 g/dL HCT 39.3 % MCV 73.0 fL WBC 21.78 10 3/¦ÌL WBC DC Neutrophil 98.0 % Lymphocyte 0.0 % Monocyte 2.0 % Eosinophil 0.0 % Basophil 0.0 %
- 12. ABG: PaO2/FiO2 AFB Result Sputum Positive 4+ ¡úTB PCR (+) ¡úTB culture: M.tuberculosis
- 13. 1. Acute respiratory failure, s/p intubation with MV since 2016/12/5 2. Septic shock 3. Suspect Pulmonary tuberculosis 4.Community acquired pneumonia 5. Pneumothorax and pneumomediastinum 6. Subcutaneous emphysema 7. Hyponatremia 8. Hyperkalemia Impression