Skip to Main Content

++

INTRODUCTION

++

CASE LEARNING OBJECTIVES

  • Identify the risk factors for developing active tuberculosis (TB) disease

  • Design a therapeutic plan for active TB disease in an immunocompetent and immunocompromised patient

  • Assess the effectiveness of therapy in patients being treated for TB

  • Design an appropriate regimen for the treatment of latent TB infection

++

PATIENT PRESENTATION

++

Chief Complaint

++

"I have had a cough for a month. Two nights ago I woke up with a sharp pain in my chest and I coughed up some blood."

++

History of Present Illness

++

HS is a 52-year-old Hispanic female who presents to the emergency department with complaints of cough, productive of small amounts of yellow sputum within the last month. She has experienced increasing fatigue, occasional SOB on exertion, and mild, nonpleuritic, substernal chest discomfort. She has had periodic night sweats; last night her temperature was 38.9°C. Two nights ago, she noticed streaks of bright-red blood in her sputum without any particular odor or taste. The only medication she has taken is an over-the-counter cough preparation. Three months ago, the patient presented to a free clinic with fatigue, increased urinary frequency, and headaches. Evaluation revealed a diagnosis of type 2 diabetes and stage I HTN. A purified protein derivative (ppd) test, required for work clearance, was placed. She was noted to have a positive ppd test, but because her chest x-ray showed no active disease, she was cleared to work.

++

Past Medical History

++

HTN diagnosed 3 months ago

++

Type 2 DM diagnosed 3 months ago

++

Depression diagnosed 9 months ago

++

Immunized with BCG

++

Family History

++

Mother (age 77 years) is in good health. Sisters (ages 49 and 56 years) have HTN. Her father in Mexico died of lung disease 4 years ago at age 72 years. Her husband died of colon cancer 2 years ago.

++

Social History

++

The patient immigrated to the United States from Mexico 1 year ago. She lives with her son and his family. She has 2 daughters who still live in Mexico and has visited them on several occasions during the past year. She has recently started working at a day care.

++

Tobacco/Alcohol/Substance Use

++

Social drinker; (−) tobacco or illicit drug use

++

Allergies/Intolerances/Adverse Drug Events

++

Penicillin (rash)

++

Medications (Current)

++

Lisinopril 20 mg PO daily

++

Metformin 500 mg PO twice daily

++

Sertraline 50 mg PO daily

++

Calcium carbonate 1,000 mg PO daily

++

Ibuprofen PRN pain

++

Alprazolam 2 mg PRN

++

Review of Systems

++

The patient reports a more-than-9 ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.