Diagnostic Dilemma


A 2½ years old boy suffering from steroid resistant nephrotic syndrome on Cyclophosphamide and steroids and on antituberculous therapy {ATT} since past 10 months was referred for further management. His Chest X-Ray showed worsening with bilateral diffuse mid-zone and lower zone haziness. He was thus suspected to have either drug resistant TB or progression of TB due to immunosuppression. He was shifted to Category II treatment regimen and advised bronchoalveolar lavage {BAL} for TB culture which showed no acid fast bacilli {AFB} even after 6 weeks. His ATT was stopped after 8 months therapy. However within a month, he again developed cough and fever. In meantime, he was now on Cyclosporine for his nephrotic syndrome along with steroids and Cyclophosphamide had been omitted. His Chest X-Ray showed left mid zone consolidation and BAL was resent for TB culture. There was AFB on smear {4 bacilli seen} but TB culture did not grow any AFB after 6 weeks.

What antituberculous therapy should be given in this child_?
Expert Opinion :
We have started the child on 2nd ATT consisting of Amikacin, Moxifloxacin, PAS, Ethionamide as he has already received 18 months of 1st line drugs without any response. Since smear was paucibacillary, it is quite likely that TB culture may be negative, but it does not rule out drug resistant TB.
Answer Discussion :
maraj ullah khan
7 years ago
abdo dabwan farea
INH. rifampicine. isoniazid
7 years ago

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