विवरण
Chronic respiratory conditions affect the lungs airways and other lung components. Asthma, chronic obstructive pulmonary disease (COPD), occupational lung illnesses, and pulmonary hypertension are a few of the most prevalent. Air pollution, exposure to chemicals and dust at work, and recurrent lower respiratory infections in children are other risk factors in addition to tobacco smoke. Chronic respiratory conditions cannot be cured. However, a number of treatments that assist widen important airways and reduce shortness of breath can help manage symptoms and enhance a patient's quality of life.
सारांश
- A 29-year-old male presented with symptoms including hemoptysis, fever, ear discharge, and previous COVID-19 treatment with steroids. Initial radiology showed a thick-walled cavity in the right mid-zone and peribronchial opacities, leading to a suspected fungal pneumonia. The patient had ear discharge and the upper respiratory tract appeared infected, leading to a broader consideration of fungal etiology.
- Further CT scans revealed cavitating nodules in the right middle and left lingula, along with the right lower lobe. Lab investigations showed leucocytosis, with a normal urine analysis except for trace protein. Cultures from oral swabs grew Pseudomonas. Bronchoscopy was performed, showing Pseudomonas aeruginosa in the ball culture, but negative fungal markers.
- Despite broad-spectrum antibiotics including piperacillin-tazobactam and amikacin, the patient's fever persisted. Clindamycin was added to cover anaerobic infections, but instead, the patient developed severe oral ulcers, prompting ENT consultation. ENT concluded CSOM from the ear and drug-induced oral ulcers.
- After stopping clindamycin and adding linezolid, the patient developed joint pains and swelling, leading to orthopedic consultation. Joint aspiration was sterile, suggesting a reactive process. Source control for sepsis was emphasized, leading to the addition of meropenem to the regimen. Skin lesions also presented as pustules.
- The lack of response to antibiotic treatment prompted a review of the patient's previous medical history, revealing that the initial diagnosis of COVID-19 pneumonia was based on radiological findings without a confirmed positive test. The patient also disclosed a history of genital and oral ulcers.
- Based on the new clues, including oral and genital ulcers, joint swelling, ear discharge, proteinuria, and cavitating nodules, vasculitis was suspected. An ANA and ANCA profile were ordered, revealing a positive ANCA result. A diagnosis of granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis, was made.
- Treatment with high-dose steroids was initiated, leading to clinical improvement. Cytotoxic therapy with cyclophosphamide was considered but declined by the patient due to concerns about infertility. Rituximab was also offered but declined due to cost. The patient was subsequently referred to a central government institution.
- GPA is a vasculitis affecting small to medium vessels, often involving the upper respiratory tract and renal system. Common symptoms include cough, breathlessness, hemoptysis, nasal discharge, hearing loss, oral ulcers, joint pains, and skin lesions. Diagnosis relies on blood tests (CBC, CRP, urine analysis, ANCA) and biopsy. Treatment involves cytotoxic agents and corticosteroids for remission, followed by maintenance therapy with azathioprine or mycophenolate mofetil. Prophylaxis against opportunistic infections like PCP with trimethoprim-sulfamethoxazole is common during cytotoxic therapy.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
डॉ. एमवी रामचंद्र
Consultant PulmonologistKauvery Hospitals.
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