Wednesday, July 12, 2006

Follow up to TB and ground glass

The patient from Yemen came to me on 4 drug thereapy based on a 20 mm PPD and diffuse ground glass. A repeat CT again showed the ground glass. Induced sputums were negative for AFB. I bronched her and the BAL was negative for AFB or other infection. The cell count was 540 WBC's with 13% eosinophils 27% lymphocytes, 12% neutrophils and 48% macrophages. The TBBx was showed nonspecific inflammation in the interstitium and type 2 pneumocyte hyperplasia. I changed her TB regimen to another month of rifampin only for latent TB. Because of her puritis, I went this way instead of INH.
Unfortunately, she is now on a plane to Yemen for at least the next 3 months. I would have liked to have gotton an echocardiogram and then an open lung. I was hesitant to start this woman on steroids and then send her off for 3 months, without having a definitive diagnosis.

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