TB Case Discussion (2015-01-21) - Case 1

Posted: 
2015-01-21
Description 

44 year old Filipino male with a history of 2 renal transplants.  Presents with fevers, dry cough and abdominal pain.  Reports some blood in sputum and pleuritic pain.

  

Exam:

—VS: T 101.8F HR 101 BP 118/78 RR 16 SaO2 100%RA
—GENL: NAD but ill appearing
CARD: RRR, S1, S2, no murmurs / rubs / gallops
PULM: bilateral crackles
ABDM: non-distended, normoactive bowel sounds, soft, tender in the epigastrium area, no hepatosplenomegaly
SKIN/Joints: no rashes, no jaundice, no arthritis<

Admission Labs:

—Wbc 6, 82% neuts, 6% lymphs, 10% monos, 2% eos
—Hb 11, Hct 36
—Plts 256
—Basic wnl: BUN 20, Cr 1
—LFTs: AST 19, ALT 20, ALP 77, bil 0.4, LDH 136
 
Questions - Differential Diagnosis?  Further work up?  Empiric therapy?

 

Speaker: 
Dr. Ruvandhi Nathavitharana
Disclosures: 
No Disclosures
Length of Presentation: 
44 minutes