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Rare Case of Drug Induced Thrombocytopenia in a Challenging Pulmonary Tuberculosis Case
( Arvindran Alaga ),( Navindran Selvaraju ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-
Introduction Thrombocytopenia in TB may occur owing to defective platelet production in the context of pancytopenia due to bone marrow infiltration, histiophagocytosis, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, immune mediated platelet destruction or as an adverse effect of therapy with rifampicin and isoniazid. We present to you a rare case of pyrazinamide induced thrombocytopenia. Case summary 34 year old male with body weight of 50kg with history of productive cough for 2 month presented with right sided pleuritic chest pain. Chest Xray revealed pneumothorax and chest tube was inserted. His FBC revealed Hb of 11.5g/dl, with WCC of 11 and platelet of 350 Inflammatory markers were raised with ESR of 80, with low albumin. He was then empirically started on T Akurit 4.TB GeneXpert and Line Probe Assay revealed M Tuberculosis complex After 73 days of treatment, we noted that platelet was gradually decreasing to 52.Decision was made to withhold Rifampicin. After 9 days of rifampicin cessation, platelet still continued to drop to 43 with sputum AFB of 2+ .Decided was made to off Isoniazid. He was then started on Ethambutol, Pyrazinimide and Levofloxacin (EZL) Despite withholding both drugs, platelet continued to drop 30. After 1 week of EZL regime, we stopped pyrazinamide, and restarted IV Streptomycin 750mg OD. Platelet then gradually increased to 84. He was then put on HREL regime for 18 days. Platelet continued to normalise to 160. Discussion Thrombocytopenia is an unusual complication of antitubecular medication. It is commonly associated with Rifampicin and to a lesser extend Isoniazid. Pyrazinamide associated thrombocytopenia are rare, therefore early detection of such causative drugs could lead to improved morbidity and outcomes.
Tennis Racket Sign - A Forgotten Sign of Active Tuberculosis
( Kezreen Kaur Dhaliwal ),( Arvindran Alaga ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-
Background Since its discovery in 1882, tuberculosis has remained a global concern. Cavitation is a common radiological finding in post primary tuberculosis, seen in 20%-45% of patients. Yet, the tennis racket sign is less commonly recognized as a finding of active tuberculosis. Methods We present a case series of five patients who presented to us with various symptoms such as chronic cough, fever, shortness of breath, and loss of appetite and weight. They were investigated for tuberculosis. Results All the five patients presented with the tennis racket sign on chest radiograph (Figure 1). Four of them were positive for sputum acid fast bacilli (AFB) smear. We proceeded with bronchoscopy for the patient who had negative sputum AFB. This patient’s bronchial washing for mycobacterial tuberculosis (MTB) Gene Xpert was tested to be positive. All of them were immediately started on antituberculosis treatment. They all showed significant improvement with antituberculosis treatment. The tennis racket sign reflects tuberculous infection of the bronchus. Narrowing or occlusion of the bronchus Results in dilatation of its distal part, which produces the cavity that is seen in this sign (red arrow, Figure 2). The sign’s proximal part is made up of the draining bronchus connecting to the hilum (blue arrow, Figure 2). The direct communication of the cavity with the bronchus explains the high bacterial yield observed with this sign. Conclusion The tennis racket sign should be acknowledged as an important radiological feature of active tuberculosis. The presence of this sign should prompt a clinician to initiate a search for tuberculosis and its treatment.