A 35-year-old female presented to our OPD complaining of cough for 1 month and low-grade fever for 1 year. She is on treatment for Lupus. She has a history of fibroid for 5 years and purpura for 1.5-2 years. His chest radiograph and HRCT is attached below:
These eruptions are noted over the skin of back and abdomen in this patient who recently discharged from the hospital.
This patient now appeared to have developed these pustules again on the same area where the vesicular lesions had first appeared. what are these new lesions? (updated on 24/08/2017)
Conversation around this case:
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| Right upper lobe abscess on follow up with CxR pa today. |
These eruptions are noted over the skin of back and abdomen in this patient who recently discharged from the hospital.
This patient now appeared to have developed these pustules again on the same area where the vesicular lesions had first appeared. what are these new lesions? (updated on 24/08/2017)
Conversation around this case:
Rakesh Biswas Thanks Vivek. Amit, DrDeepanjan will be looking forward to your and others inputs on this current patient
Rajendra Takhar Looking at the under treatment status for lupus and two of the cardinal symptoms of tuberculosis with supportive evidence from radiology, I would definitely recommend Anti-tuberculous therapy. Bacteriological confirmation is advised but not necessary in this scenario.
Rakesh Biswas Thanks Rajendra
DrDeepanjan Bhattacharya What is the treatment status for lupus? Any immunosuppressive therapy?
I think that at least a microbiological work up is warranted before starting att
Sputum and mantoux at least.
I think that at least a microbiological work up is warranted before starting att
Sputum and mantoux at least.
Michele Meltzer What treatment?
Rakesh Biswas Thanks DrDeepanjan and Michele. She was on prednisone 40 mg and azathioprine 50 mg (stopped a month back ). Her sputum AFB is negative
Boudhayan Dm Her diabetes has gone from one end to the other..... I guess from 730 to begin with to Occasional hypos now.
Boudhayan Dm Sir she was receiving Cyclophosphamide and steroids recently. The initial Rx had Azathioprine and Prednisolone. She was Rx ed with HCQS also in the beginning. Now she has an ascites also. Her initial presentation was diagnosed as Autoimmune Hepatitis.
Amit Taneja I would favor establishing microbiological diagnosis with at least a BAL if possible.
Rakesh Biswas She had copius amounts of sputum and somehow this made the pulminologist feel that BAL may not help (short of a PSB). Also they felt overall as well as radiologically that these cavities could be due to the usual bacteria causing lung abscess and so she is just on cephalosporin antibiotics (also as we were suspecting spontaneous bacterial peritonitis due to the cirrhosis and ascites from her autoimmune hepatitis)
Rakesh Biswas Also she appeared to be allergic to penicillin (ampilcillin and cloxacillin on routine skin testing before the iv dose...not sure if it still recommended though).
Rakesh Biswas This lady has been doing reasonably well without antitubercular therapy till date and her insulin dose requirements and necessary adjustments appear to have been addressed optimally through whatsapp messaging.
Amit Taneja Probably polymicrobial lung abscess
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