Diagnostic Dilemma

TUBERCULOSIS WITH THROMBOCYTOPENIA ON TREATMENT


Author: Pediatric Oncall
Question
A 9 years old boy presented in with multiple neck swellings and weight loss for 2 months. Elder sister was diagnosed as multi drug resistant tuberculosis (MDR-TB) and was on second line antituberculosis therapy (ATT) for the same. Her drug sensitivity test (DST) showed resistance to Isoniazid, Rifampicin, Streptomycin, Ethambutol and Pyrazinamide. The boy was thus investigated for TB and ultrasound abdomen showed few mesenteric lymphnodes, Chest X-Ray showed primary complex and mantoux test was positive (18 mm x 18 mm). His CT abdomen showed circumferential wall-thickening of terminal ileum and ileocaecal region with perifocal enlarged lymphnodes in right iliac fossa suggestive of TB. He was thus started on Amikacin, Ofloxacin, PAS, Ethionamide and Cycloserine. However 3 months later, child had thrombocytopenia.

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