This case will test your comprehension of the Therapy of Tuberculosis.

A 38 year old black male consults you because of cough, sputum production and mild hemoptysis. He has had evening rise of temperature for the past one month and claims to have lost 30 lbs. over a three month period. On exam he appeared to be chronically ill and wasted. Cavernous breath sounds are heard over the right apex. Chest x-ray shows fluffy infiltrates and some amount of contraction of the right upper lobe. There is a cavity in the superior segment of the right upper lobe. A working diagnosis of tuberculosis is made. Sutum is positive for AFB. The patient was started on INH, Rifampin,Pyrazinamide and Ethambutol.

1. You get a panic call from the patient that evening. He complains that his urine is orange red in color. What will you do?   Answer

2. What are the primary drugs for tuberculosis? Why were these drugs were chosen for this patient?  Answer

3. The patient is anxious to go home. He wants to know how long you are going to keep him in isolation.  Answer

Two weeks passed by. The sputum smears are still positive. 

4. Will you still discharge him?  Answer

The patient returns in two months with fever, weight loss, anorexia and slight nausea. Sputum smears are negative for acid fast bacilli. The patient thinks the problems are secondary to medication.

5. Could he be correct?  Answer

6. Should he have been monitored more closely?  Answer

He develops jaundice the day after hospitalization. 

7. What do we do with anti tuberculosis therapy?  Answer

He is sent home on rifampin, ethambutol and pyrazinamide. His jaundice clears and the patient steadily improves.

8. Why were two additional drugs added?  Answer

He returns in four months. He feels great and has gained 35 lbs. His chest x-rays reveals some minor residual scar. He is anxious to stop all medications.

9. What will be your advise regarding duration of anti tuberculosis therapy and why? Answer

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