What's Your Diagnosis?

Abstract

What's Your Diagnosis?What's Your Diagnosis? Husn Frayha, MD Mansour Al Nozha, and FRCP Ghazi M.S. SiddiqueBSc, MD Husn Frayha Search for more papers by this author , Mansour Al Nozha Search for more papers by this author , and Ghazi M.S. Siddique Search for more papers by this author Published Online:1 May 2000https://doi.org/10.5144/0256-4947.2000.331SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutHISTORYA 70-year-old Saudi male was admitted at Khamis Civil Hospital with persistent fever, cough with expectoration and progressive dyspnea on exertion. The patient had no history of asthma or other allergies and was a nonsmoker. His past history indicated that he had previously been diagnosed as a case of pulmonary tuberculosis and had been given antituberculous treatment with no improvement in his condition. On examination, the patient appeared pale and febrile (39.2°C) with no dehydration, and pulse rate was 100 per minute. Chest examination revealed bilateral crepitations on the right side, with no other abnormalities detected. Laboratory findings were as follows: ESR 105 mm/hour and Hb 10 g%. Intermediate PPD test (five tuberculin units) was negative.Chest X-ray showed multiple, thin-walled cystic lesions in the right upper lobe, ill-defined opacities in the left mid-zone areas, parenchymal lesions in left mid- and left lower zone areas with loss of outline of left dome, as well as left pleural effusion. The patient's decontaminated sputum was subjected to Ziehl-Neelsen staining/acid-fast staining (Figure 1), Gram's staining (Figure 2), and culture on brain heart infusion agar. Culture of patient's decontaminated sputum on brain heart infusion agar yielded growth of white irregularly folded and furrowed colonies, which were granular and powdery, with an earthy odor after incubation at 45°C aerobically for one week. Biochemical test findings of the micro-organism isolated were urea test positive, and gelatin liquification and fermentation of carbohydrates were negative.What is the clinical diagnosis?What is the treatment? Previous article Next article FiguresReferencesRelatedDetails Volume 20, Issue 3-4May-July 2000 Metrics History Published online1 May 2000 InformationCopyright © 2000, Annals of Saudi MedicinePDF download