DENOUEMENT CONTINUED FROM PAGE 15 YOUR DIAGNOSIS PLEASE?

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PANAHI M.

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Journal: Medical Journal of Mashhad University of Medical Sciences Year:2007 | Volume:50 | Issue:95 Page(s): 110-112

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Title

DENOUEMENT CONTINUED FROM PAGE 15 YOUR DIAGNOSIS PLEASE?

Author(s)

PANAHI M. | Issue Writer Certificate

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Abstract

An important problem with chronic hepatitis C is indolent course of disease, however, given sufficient time, chronic hepatitis C many progress to cirrhosis, hepatocellular carcinoma and it is estimated that the number of deaths caused by chronic hep C and related diseases will triple in the next decade. One of the various extrahepatic manifestations of chronic hep C is essential mixed cryoglobulinemia. This syndrome is a systemic vasculitis with remarkable manifestations including: pupura, neuropathy, glomerulonephritis, hepatosplenomegaly.Nephritic synd is the most common manifestation of cryoglobulinemia but in spite of positive cryoglobulin of serum of patient. There was no marks of kidney involvement. Cryoglobulinemia is found in one third of patients with HCV; but only 1-2% of these patients develop essential mixed cryoglobulinemia. This patient had no symptoms and Signs of renal disorder and besides had no purpura with a normal complementemia , indicated his pulmonary manifestation is not due to HCV infection.On clinical examination he had one and half kg weight loss. Low grade fever, exertional dyspenea and in last CBC report there was a hyperleukocylosis (19000) with neutrocytosis (75%) and 10% bandemia.B and neutrophils are younger forms than segmented neutrophils. Band neutrophils account for less than 4% of total circulatory neutrophyls. Bandemia (greater that 7%) suggests that bone marrow is releasing granulecytes early; and suggests that severe infectious process is happened (severe sepsis). Especially when it is associated with hyperleukocytosis.Chest. X. Ray of patient showed many pulmonary nodules and alveolar infiltration in C.T.Scan imaging, indicated a severe infection in the right lung with a plural reaction in the same side (pleural effusion).Non- infectious processes like pulmonary infarction, eosinophylic pneumonia and lung vasculitis are unlikely (due to CBC test and normal ANA, C3 and C4) Strongyloidiasis; disseminated form, without peripheric eosinophylia is not acceptable. Rhodococus infection a zeonosis of horses and humans in immunocompremised patient (Post HCV cirrhosis) because of absence of contact with horse in his history of patient is not suggested. Bartonellosis has been reported with pulmonary nodules in immuno compremised patients. Mycobacterial infections may occur in immunocompotent and immunocompremised patients, but the nodules if present would appear with cavitation. Cryptococcus also was unlikely, there was no history of contact with birds; and patients with cryptococcus infection have a very high temperature (42°c) permitting fungus growth. And lung infection is usually with meningitis. Pulmonary Candidacies usually is following of disseminated candidiasis and pulmonary nodules in this infectionis milliaryform and patients with candidias is have the history of antibiotic- therapy with neutropenic picture in white blood cell count.Nocardiosis is another diagnosis that would explain illness. The organism usually involves the lungs, so pulmonary infection is common form of disease. This organism is an Actinomycete with branching filaments, usually Gram positive on Gram's staining and variable results on acid fast staining. Pulmonary nodules are found in majority of cases. These nodules may be associated with pleural effusions. Nocardia is an infection of both immunocompromised and immunocompotent patients. And in patients with some immunologic disorders like our patient; HIV- infected persons and in persons with renal transplantation, the incidence of disease is high. Nocardia infection can occur in healthy persons, COPD, AIDS, cirrhosis and some other diseases. So The main considerations diagnosis in this case are Mycobacteriosis (T.B and none T.B infection) and Nocardiosis and diagnostic procedure is pleural effusion aspiration and bronchoalveolar lavage, gram staining of samples and cultures of specimens for nocardia and mycobacterium.Conclusion& Results: Diagnosis of Nocardiosis is based on culture. Smear of sputum and Gram staining that shows organism as weakly acid fast filaments, but partial acid fast staining is a specific staining that rules out other species of Actinomycetes. In this case, the lungs involvements were not due to extraliver manifestation of HCV infection. The two main diagnostic consideration in this case are Mycobacteriosis and Nocardiosis, but in needle pleural aspiration and smear and culture of sputum nocardia grew as weakly acid fast filaments and eventually the organism broke down in pleomorphic cocobacilli; a process necessitates for confirming the growing of nocardia. Because of an opportunistic infection following HCV cirrhosis it is necessary to determine the extention and metastatic spread of infection. But there was no signs and symptoms of extention of nocardia infection. The patient received co-trimoxazole and tolerated it well. After 4 week treatment, patient's situation was much better and he was told to continue the medicin for nine months. With suspicious of association of Nocardia with Pneumocystice Carinii and Listeriosis co-trimoxazol covers all of these infections.

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References

PULMONARY NOCARDIOSIS IN AN IMMUNOCOMPETENT PATIENT

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APA: Copy

PANAHI, M.. (2007). DENOUEMENT CONTINUED FROM PAGE 15 YOUR DIAGNOSIS PLEASE?. MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES, 50(95), 110-112. SID. https://sid.ir/paper/51333/en

Vancouver: Copy

PANAHI M.. DENOUEMENT CONTINUED FROM PAGE 15 YOUR DIAGNOSIS PLEASE?. MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES[Internet]. 2007;50(95):110-112. Available from: https://sid.ir/paper/51333/en

IEEE: Copy

M. PANAHI, “DENOUEMENT CONTINUED FROM PAGE 15 YOUR DIAGNOSIS PLEASE?,” MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES, vol. 50, no. 95, pp. 110–112, 2007, [Online]. Available: https://sid.ir/paper/51333/en

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