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Case (84)



A 25 year old male who is a long distance truck driver, came to me with a productive cough, weight loss, difficulty breathing & poor appetite.
From these images, what is your differential diagnosis?
What will be your first lab request & why?
Any other investigation you must do before you start treating this patient?
What is the pathognomonic finding on this scan that will confirm your diagnosis if your first lab request come back negative?
Let us discuss....

Xabadan Dhawr sanno (6 years) bay jawaab laadahaye! ;D ;D ;D

CT shows bilateral upper lobe cavitations with consolidation, this is accompained by a sinister history of weight loss and poor Appetite.
The patient is also a long truck driver denoting travel across borders and possibly a red-herring for a certain adventurous lifestyle!.

My top diagnosis is Pulmonary tuberculosis.

However, I would like to rule out to conditions. HIV and Infective endocarditis.

My assessment would obviously start by the bedside, basic observations, oxygen saturation, heart rate, respiratory rate and Blood pressure.

I would start with a basic blood panel, FBC (might show raised WCC and Anaemia), CRP, Biochemistry (looking for AKI or deranged LFTs). 3 sets of blood cultures and HIV screening.
I would also request a urine dip and early urine specimen for TB
Sputum Culture and sensitivities. Sputum culture for AFB and culture.

Now the most likely possibility is still TB, therefore provided there are no contraindications to treatment, I would start treatment straight away.

However, always keep an open mind. if the story doesn't fit consider other causes of such findings, Staph aureus in IE could cause bilateral cavities, Autoimmune diseases could also present with cavities.

Xaaaji. bal naga fuji.. hadaba



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