The Common Vein

• 35 yo. male with recently diagnosed
  • AML and
  • disseminated TB with
    • pulmonary TB, cervical
    • lymphadenitis, and
    • innumerable liver and
    • spleen lesions
      • likely due to TB
        • RxHRZEHe was diagnosed with TB during a prolonged hospitalization (1 year ago during which he was also diagnosed with AML. His hospital course was notable for persistent daily fevers and an extensive work up was unrevealing. He received chemotherapy (7+3) on 1 year ago
        • and a day 28 BMbx was negative,
        • though peripheral smear showed a circulating blast and he was then started on HiDAC consolidation
      • 1 year ago AML and TB
      • Focal Consolidations

        • 

          

          

          Lympadenopathy 1 year Ago

          

          Cavitating Nodule

          

           

        • LUL Nodule

        • 

          Tree in Bud Nodules

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        • Liver and Splenic Lesions 1 year Ago

        • 

          

          

          

          

        • Liver biopsy 1 year ago 
        • Path – Non-necrotizing granulomas and
        • negative AFB smear and culture.

        • 
        •  A Month Later
        • Neck Lymph Nodes Early Necrosis

        • 

          Growing Consolidation in the LUL

          

           

        • 1 Month Later after Treatment
        • Smaller but Cavitating 

        • 

          • Repeat Liver biopsy 10 months prior
          • Path – Necrotizing Granulomas and
          • negative AFB smear and culture.
        • 
        • Resolution of the Tree in Bud Changes in the RUL
        • 7 Months Later Improving but Persistent Cavitation
        • 3months Later
      • 11monthsago
        • 
        • 10 monthsago
        • 
        • 6 Months ago Active Disease
        • • Chest
            • RLL cavitary lesion and
            • LUL lesion t
              • significant worsening of
              • diffuse tree-in-bud opacities.
              • necrotic appearing LN in the R cervical chain.
                • sputums
                  • AFB smear neg x 3,
                  • NAAT neg x 2, and
                  • cultures negative.
                • bronchoscopy and BAL specimens
                  • negative.
                  • Rx regimen
                  • added
                    • INH, Rifampin and PZA.
        • 
          • Repeat Liver biopsy 6 months prior
          • Path – Necrotizing Epithelioid  Granulomas and
          • negative AFB smear and culture.
          • • multiple necrotizing epithelioid granulomas.
          • 
        • 
        • 
        • 
        • 
      • 
        • 3 months ago
        • 
        • 
        • 
        • Lesions increased in size
        • • • • • Repeat CT  4mths ago
                  • resolution of tree-in-bud opacities in bilateral lungs
              • 3 months ago
                • neck -ecrotic LNs
                • 
                • Liver lesions
                  • increased in size
                • Splenic lesions
                  • increased in size.
                • R paratracheal LN I
                  • increase in the size of a at the level
                • 

 

Problem List Items Addressed This Visit

Other
• Disseminated tuberculosis
Relevant Medications
rifaMPIN (RIFADIN) 300 MG capsule
pyrazinamide 500 mg tablet
levoFLOXacin (LEVAQUIN) 750 MG tablet
ethambutoL (MYAMBUTOL) 400 MG tablet