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Tuberculosis a Common Theme

 I am realizing that many of my memorable patients had tuberculosis. This next story also fits that same theme. A few years ago, there was an ill-appearing 7 year-old girl, whom I will call Mary, who came in with a few day history of a swollen right thigh and fever. She was admitted and treated with antibiotics, but her condition was not improving. Her knee was becoming stiff, so we took some fluid out of her knee joint (which ended up being pus) and placed a drain in her knee. A few days later, she also had an abscess in her thigh which we drained. Not long after that, she began having difficulty breathing, so a chest X-ray was done.  It showed that her heart was enlarged and she had a pneumothorax (air inside the chest but outside the lung). I did an ultrasound on her heart to see the cause of the heart enlargement, and it showed a pericardial effusion (fluid around the heart that isn’t supposed to be there) as well as heart failure (the heart was not pumping well). I also placed a chest tube for the pneumothorax. Over the next several days, Mary was placed on several antibiotics to cover almost any bacteria possible, but she continued to spike high fevers and not improve much. She did not have much cough and did not have sputum, so we were unable to test for pulmonary TB. After much thought and prayer, I finally decided to start her on anti-tuberculosis treatment to treat suspected TB pericarditis (infection of the sac around the heart) and TB osteomyelitis (infection of the bone). Oftentimes in children, particularly in our setting where specialized TB tests are not available, a diagnosis of TB (more commonly extrapulmonary-TB outside the lung-in children) is confirmed after the patient responds favorably to empiric TB treatment. After a few weeks of anti-tuberculosis treatment, Mary began to improve dramatically and her fevers disappeared. She had always looked so tired, sick, and unhappy during the first several weeks in the hospital.

Now she was a happy, playful little girl with a big smile (along with her mother).

Originally posted by the Cahills on Nov. 5.

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