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- 저자 : ( Jose Ribeiro Almeida ) (검색결과 1 건)
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Poster Session : PS 0605 ; Pulmonology ; How Far Can We Go without Empiric Treatment?
( Lise Brosseron ),( Sara Almeida Pinto ),( Jose Ribeiro Almeida ),( Tiago Pereira ),( Judite Quintas ),( Vitor Paixao Dias ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Tuberculosis is a known cause of fever of unknown origin. Nowadays most authors consider mycobacterium tuberculosis isolation essential prior to treatment. Case Report: A 63 year-old women was admitted to our department with vespertine fever, night sweats, anorexia and weight loss in the past 4 months. She had a history of childhood pulmonary tuberculosis, with sequelar bronchiectasis. Besides paleness and low BMI no other relevant physical fi ndings were observed. Laboratory evaluation revealed anemia and elevation of CRP and ESR. Thorax-CT showed bronchiectasis on the upper and inferior right lobe. Bronchoalveolar lavage cultures were negative to bacteria, mycobacteria and fungus as well as M.tuberculosis complex DNA. Despite multiple antibiotic courses she maintained intermittent pyrexia. After excluding most relevant causes of fever of unknown origin, a PET scan confi rmed exclusive involvement of the right superior pulmonary lobe. In the second bronchofi broscopy signifi cant bronchial hemorrhage was visible, so catheter embolization of the right bronchial artery was performed. An arterio-arterial subclavian-pulmonary fi stula was detected. Two days later multiple infra and supratentorial intracerebral hemorrhages were diagnosed. In the following week she had two ischemic strokes affecting the right and left middle cerebral artery territory. Transcranial Doppler showed moderate right-to-left shunt. All those events were suggestive of embolic etiology. Despite all negative cultural and DNA results, attending to typical manifestations, exclusion of other foci and to this rapid deterioration, empiric treatment was started with isoniazid, rifampin, ethambutol and pyrazinamide. One month after treatment initiation, persistent apyrexia was obtained with normalization of all infi ammatory parameters. In the last 3 months good evolution of pulmonary lesions and signifi cant improvement of her neurologic state were observed. Conclusions: We present a bizarre case of tuberculosis with catastrophic consequences, which demonstrates that empiric treatment still has its place in modern medicine.
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