Diagnostic Dilemma - Pediatric Oncall
Author: Pediatric Oncall
A 1½ years old girl presented with cough for 15 days and breathlessness for 8 days in November 2009. She was treated for pulmonary TB in April 2009 for 6 months. Grandfather had tuberculosis 1 year back and had received antituberculous therapy {ATT} for same. On examination, weight was 7.2 kg and height was 75 cms. Air entry was decreased in right supra-mammary region and she had bilateral crepts along with cardiomegaly. Her Chest X-Ray showed right paracardiac laziness with cardiomegaly. CT chest showed consolidation in right upper lobe with cavitating nodule in right middle lobe with few mediastinal hilar lymph nodes. Echocardiography showed dilated cardiomyopathy with non-compacted left ventricle and fractional shortening of 20 percent with ejection fraction of 40 percent. Her serum calcium, ammonia, CPK were normal. Bronchoalveolar lavage did not grow any acid fast bacilli after 6 weeks of culture. She was started on Category 2 of ATT along with furosemide and enalapril.
Answers of this discussion
Author :- fificash ad on 18 October 2011.
Answer :- it is a rare condition but it is the most near diagnosis.

Author :- Rajeev Malhotra on 19 October 2011.
Answer :- pulmonary hypertension

Author :- Olumuyiwa Oso on 19 October 2011.
Answer :- Tuberculous myocarditis

Author :- Jose Samosc on 21 October 2011.
Answer :- Can present with core-pulmonale secondary pulmonary hypertension.

Author :- habib jawaid on 21 October 2011.
Answer :- yes it is possible

Author :- drRanjith kumar on 21 October 2011.
Answer :- 1.cardiomyopathy may be different event due to viral myocarditis. 2.rare possibility may be due to TB cardiomyopathy

Author :- neelesh kumar on 23 October 2011.
Answer :- tuberculosis can cause dilated cardiomypathy

Author :- Rolando Lezama on 24 October 2011.

Author :- radhabinod pal on 24 October 2011.
Answer :- the wt and ht of the patient are below or near below 3rd percentile suggesting of malnutrition.The dilated cardiomyopathy may be due to long standing anemia or nutritional deficiency of micro nutrients like selenium, zinc ect or carnitine deficiency. There may be previously hidden viral myocarditis. T.B does not cause dilated cardiomyopathy itself directly.

Author :- walid elsogier on 26 October 2011.
Answer :- here i must suspect treatment YES WE CAN SUSPECT TB

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