posted in Medisage Pulmonology Community
- A 43-year-old male presented with Dyspnea(Mmrc grade2) since 3years and Bilateral watering of eyes (recurrent uveitis) since 3 years and dimness of vision since 2 months.
- Chest radiograph shows bilateral Reticulo nodular opacities in middle and lower zones.
- Hrct thorax suggestive of miliary pattern with enlarged lymph node [subcarinal measuring 20*12mm].
- BAL + TBLB
- Biopsy showed granulomatous inflammation,
- Bal TB culture showed no growth.
- M.TB not detected in the CBNAAT of the sample.
- Patient also had cataract in the right eye with vitreous opacities.
- Previously, he had taken antitubercular treatment (HRZE) for two times of 6 months each.
- First course of treatment
- HRCT was suggestive of bilateral multiple enlarged and necrotic lymph nodes(largest is subcarinal measuring 2.3cm) .
- Serum ACE – 52.7 Serum calcium – 8.1
- EBUS-TBNA
- cytology s/o chronic granulomatous lymphadenitis.
- Histopathology s/o reactive lymphoid tissue.
- based on which HRZE was started and completed for 6 months, and oral, topical steroids were given in view of recurrent uveitis.
- Second course of treatment
- CT-guided biopsy:
- s/o epitheliod cell granulomas.
- Based on this he had taken antitibercular treatment for 6 months.
- In view of recurrent uveitis and past history of 2 courses of anti-tubercular treatment genome sequencing of the vitreous fluid derived from micro-incision vitrectomy with phacoemulsification of the right eye was done.
- genome sequencing of vitreous fluid revealed M. Tuberculosis resistant to first-line drugs(HRZES).
- #pulmonology
- #ophthalmology
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