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Case Study VI

A 45-year-old homeless man presents with a 2-month history of fatigue, weight loss, fevers, night sweats and a productive cough. A chest x-ray shows a right apical infiltrate and a sputum smear shows many acid-fast bacilli. He is also HIV-positive. Standard treatment for presumptive pulmonary tuberculosis is indicated due to the positive sputum smear, along with consideration for potential medication toxicity given his medical history.

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Shashidharan Menon
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133 views

Case Study VI

A 45-year-old homeless man presents with a 2-month history of fatigue, weight loss, fevers, night sweats and a productive cough. A chest x-ray shows a right apical infiltrate and a sputum smear shows many acid-fast bacilli. He is also HIV-positive. Standard treatment for presumptive pulmonary tuberculosis is indicated due to the positive sputum smear, along with consideration for potential medication toxicity given his medical history.

Uploaded by

Shashidharan Menon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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[CASE STUDY VI] April 18, 2013

A 45-year-old homeless man presents to the emergency department complaining of a 2-month


history of fatigue, weight loss (10 kg), fevers, night sweats, and a productive cough.

He is currently living on the street but has spent time in homeless shelters and prison in the last
several years.

He reports drinking 2–3 pints of hard alcohol per day for the last 15 years, and he also reports a
history of intravenous drug use.

In the emergency department, a chest x-ray is obtained that shows a right apical infiltrate.
Given the high suspicion for pulmonary tuberculosis, the patient is placed in respiratory
isolation.

His first sputum smear shows many acid-fast bacilli, and a rapid HIV antibody test returns with a
positive result.

1. What drugs should be started for presumptive pulmonary tuberculosis?

2. What is the purpose of combination therapy in the treatment of tuberculosis?

3. Does the patient have a heightened risk of developing medication toxicity?

4. Which medication would be likely to cause toxicity?

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