A CASE OF LUNG ABSCESS

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PRESENTING COMPLAINTS : 

PRESENTING COMPLAINTS Mr. k, 24/M, Food supplier in a private corporate hospital Admitted with complaints of Cough &sputum - 1month Wheeze - 1month Fever - 1month Breathlessness - 1month

H/O PRESENTING ILLNESS : 

H/O PRESENTING ILLNESS Cough 1 month, Productive,throughout the day,worsened on lying to left side& relieved by lying to right. Sputum 1month, 10-15ml/day, Yellow/purulent, Not foul smelling. Wheeze 1months. Associated with coughing episodes Known asthmatic since age of 15 yrs.

H/O PRESENTING ILLNESS : 

H/O PRESENTING ILLNESS Breathlessness 1month. Aggravated: Exertion. Relieving factor: -rest. &cough Fever 1 month, high grade, persistent ,no chills and rigor. h/o hemoptysis -2episodes last 1 month ,about 20ml/day, 10 days apart , no chestpain.

PAST MEDICAL HISTORY : 

PAST MEDICAL HISTORY Known asthmatic. On MDI from age twelve. No H/o ATT. Not a known diabetic / Hypertensive. No H/o eczema / atopy. Drug history-On salbutamol& budesonide inhaler. H/o steroid injection on & off.

Social history : 

Social history Not a smoker / alcoholic Single, only son of non consanguineous parents. No h/o atopy in family. Occupation - food server in private corporate hospital.

Physical examination : 

Physical examination . Conscious, oriented, Well build & well nourished. Febrile No p.edema /cyanosis/ tremors/pallor/icterus/Lymphadenopathy No clubbing, JVP not elevated No oral ulcers, good oral hygiene. Vitals : BP: 110/80, PR : 94/min, RR: 21/min, abdominothoracic ,temperature-100 f

Examination of upper respiratory tract : 

Examination of upper respiratory tract normal.

Examination of the Lower Respiratory System : 

Examination of the Lower Respiratory System Inspection: Shape-normal, breathing pattern-abdominothoracic rate-21/min. Movement- symmetrical.Trachea- midline. Palpation: Trachea-midline. Apex beat: left 5 ic space half an inch medial to midclavicular line.

Examination of the Lower Respiratory System : 

Examination of the Lower Respiratory System Percussion: Impaired resonance in right lower interscapular area. Auscultation: NVBS ,crepitation in right lower interscapular areas. Wheeze B/L +

EXAMINATION OF OTHER SYSTEMS : 

EXAMINATION OF OTHER SYSTEMS Cvs :Heart sounds heard normally. No murmur. P/A: no palpable organomegaly. CNS: normal.

INVESTIGATIONS : 

INVESTIGATIONS Sputum AFB-30/05/09-Negative. (A,B,C) samples. HIV - nonreactive. CBC- TC: 15.2 n-85 l-10 e-5 , HB%-10.2, platelets-1.60lakhs. Blood urea: 25, Sr.creatinine-1.0 , Blood sugar-90mg. LFT - S.bilirubin: 0.6. SGOT -66. SGPT-30. SAP_137. S.protein-7.4 aibumin-4.8, globulin-2.6 Smear- Mp/Mf- negative. Mantoux- nil.

CXR : 

CXR

Slide 13: 

Antibiotics started- Inj crystalline penicillin 100lakhs I.U. od . Inj cefotaxime 1 gms IV bd. Inj. Metronidazole 500 mgs IV tds. Nebulisation salbutamol/ipratropium bromide 4hrly Inj. Deriphylline 1 tds. Initial -3days.

INVESTIGATIONS : 

INVESTIGATIONS US Chest- no pleural effusion. Ultra sound abdomen- normal. sputum nt culture- No growth. MINI GTT- F:- 78 mg, Pp- 110mgs.

Slide 16: 

Antibiotics – Inj. Ciprofloxacin400mgs IV bd. Inj. Metronidazole 500 mgs IV tds . Inj crystalline penicillin 100lakhs I.U. IV od . Nebulisation salbutamol/ipratropium bromide 4hrly Inj. Deriphylline 1 tds Subsequent week- Inj amikacin750 mgs IV od. added

FIBRE OPTIC BRONCHOSCOPY : 

FIBRE OPTIC BRONCHOSCOPY Vocal cords- normal, moves equally with phonation. Trachea – normal. Carina –sharp. Bronchi – left main &bp segments normal. Right - middle lobe-inflammed, lower lobe 6 segment edematous mucosa. Pus extruding from lower lobe segments . Washing & Brushing done.

Slide 18: 

Bronchial aspirate -AFB negative. Gram staining -many Gram positive cocci in lumps s.aureus. Blood culture – no growth .

Slide 19: 

18/06/09- sputum NT culture done. S.aureus growth , resistance to Ampicillin, oxacillin, methicillin, cefotaxime, ceftriaxone, amikacin, gentamicin, ciprofloxacin. Intermediate sensitivity- vancomycin, cephalothin.

HIDRADENITIS SUPPRATIVA : 

HIDRADENITIS SUPPRATIVA

Slide 22: 

After the culture results pt started on I.V. Vancomycin 750 mg bd. C.clindamycin 300 mg tds. Blood urea, sr.creatinine after 10 days were 20& o.7 .

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