The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

38 V. SIVARAMAN ETAL
Table 2. Some peculiar radiographic features of tuberculosis among patients with AIDS
Presence of
cavitation
Hilar
adenopathy
Diffuse/
miliary
Pleural
effusions
Chaisson et al 1 1 (35) 4 (35) 12 (35) 4 (35)
Pitchenik and Rubinson 2 0 (17) 10 (17) 1 (17) 2 (17)
Modilevsky et al 3 3 (29) 10 (34) 2 (17) 8 (28)
Present series 3 (6) 2 (6) 2 (6) 0 (6)
Numbers within brackets indicate the total number of cases in the series.
Case 4
An unmarried female aged 21 years was
admitted on 23.1.1991 with cough and
expectoration of 1 month duration and fever off
and on. On examination, the patient was febrile
(38°C). Auscultation of the lungs revealed
scattered crackles but, otherwise, the physical
examination was non-contributory. The
roentgenogram of the chest showed a well
demarcated oval shadow in left upper zone. The
sputum smear was positive for AFB. Casoni's test
was negative. ELISA was positive and Western
Blot result is awaited. No history of sexual
promiscuity or blood transfusion could be elicited
despite repeated questioning.
The patient was put on Ethambutol, INH,
Rifampicin and Pyrazinamide on 1.2.1991.
Treatment had to be stopped on 12.3.1991 due to
petechial and ecchymotic lesions over both the
feet and ankles : the lesions were symmetrical
with excoriation marks and mild edema over and
about the lesions. The movement of both the
ankle joints was painful and the lesion blanched
on diascopy. There were no purpuric spots on the
palate, suggesting that the lesions were on
account of allergic vasculitis due to drugs. The
skin lesions responded to topical application of
calamine lotion and oral antihistaminics. The
total/differential leukocyte and platelet counts,
liver function tests, blood urea, serum creatinine,
and urine examination were all within normal
limits. Anti-tuberculosis treatment with INH and
Ethambutol was restarted after desensitisation
for INH. The general condition improved and the
patient was discharged on 15.5.1991 to continue
ambulatory treatment. She is being followed up,
Case 5
A male aged 48 years, rickshaw puller and a
known alcoholic was admitted on 16.1.1991 with
cough and expetoration of one month and itchy
skin lesions of 2 weeks' duration. On
examination, the general condition was fair.
There were extensive infected scabies lesions
involving face and both the palms. There were
coarse crackles over both the lungs.
Roentgenogram of the chest showed diffuse
bilateral infiltrations with multiple small cavities.
Sputum smear was positive for AFB; ELISA test
was positive and Western Blot result is awaited.
Since the serum bilirubin was found raised on
admission, a relatively non hepatotoxic regimen
of Streptomycin and Ethambutol was given till
the return of liver function to normal. Thereafter,
a regimen of Ethambutol, INH, Rifampicin and
Pyrazinamide was given on alternative days for 1
month, till sputum conversion was obtained. The
infected scabies was treated with antibiotics and
thrice weekly 25% benzylbenzoate applications
till complete clearing was obtained. The patient is
continuing INH and Ethambutol daily on an
ambulatory basis.
Case 6
A female patient aged 24 years was admitted
on 23.1.1991 with cough and expectoration, loss
of weight, loss of appetite and chest pain. On
examination, the general condition was fair, there
were crackles over the right interscapular lung
area, sputum smear was positive for AFB and
roentgenogram of chest showed multiple cavities
and patchy pneumonitis over the right upper
zone. Both ELISA and Western Blot tests were
positive.
A regimen of Ethambutol, INH and
Rifampicin was started. The course of the disease
during the hospital stay was uneventful except for
the appearance of cervical adenitis. The nodes