Rare cause of paradoxical worsening of pleural effusion in a patient with tuberculosis duraikannan p, saheer s, balamugesh t, christopher d j – lung india

A 33-year-old patient, Known case of chronic kidney disease on maintenance dialysis presented with complaints of low-grade fever and weight loss of 2 months duration. Symptoms of bone marrow cancer Computed tomography (CT) revealed bilateral mild pleural effusion with significant mediastinal and abdominal adenopathy. Bone marrow transplant survival rate CT-guided fine-needle aspiration cytology of abdominal lymph nodes and bone marrow culture was suggestive of tuberculosis. Bone marrow transplant youtube The patient was started on four drug anti-tubercular therapy, post 6 weeks of initiation he developed new onset fever and chest X-ray revealed moderate right pleural effusion.

White blood cells in bone marrow Diagnostic thoracocentesis was suggestive of chylothorax. Purpose of bone marrow To the best of our knowledge, this is the first case report of chylothorax due to the paradoxical reaction in the HIV-negative tuberculous patient.

Keywords: Chylothorax, immune reconstitution inflammatory syndrome, paradoxical reaction, tuberculosis

How to cite this article: Duraikannan P, Saheer S, Balamugesh T, Christopher D J. Bone marrow loss Rare cause of paradoxical worsening of pleural effusion in a patient with tuberculosis. Role of bone marrow Lung India 2017;34:167-9

How to cite this URL: Duraikannan P, Saheer S, Balamugesh T, Christopher D J. What is the function of bone marrow Rare cause of paradoxical worsening of pleural effusion in a patient with tuberculosis. A bone marrow biopsy Lung India [serial online] 2017 [cited 2017 Mar 13];34:167-9. Red bone marrow is found in spongy or Available from: http://www.lungindia.com/text.asp?2017/34/2/167/201315

Paradoxical reaction (PR)/immune reconstitution inflammatory syndrome (IRIS) is an exaggerated and dysregulated inflammatory response to the microorganism. Bone marrow leukemia It manifests when a sudden shift of host immunity from an immunosuppressed and anti-inflammatory state toward a proinflammatory state. Be a bone marrow donor [1], [2] Here, we present a case, probable the first report in the literature about PR in HIV-negative tuberculosis (TB) patient presenting as chylothorax.

A 33-year-old man, diagnosed case of chronic kidney disease secondary to diabetes mellitus on maintenance dialysis presented to pulmonary medicine outpatient unit with complaints of intermittent fever and weight loss of 2 months duration. Where is red bone marrow located On examination, he was febrile (38.4 Celsius) with a respiratory rate of 20/min, pulse rate of 104/min, blood pressure of 140/90 mmHg, and oxygen saturation of 96% on room air. Cancer in the bone marrow General examination revealed pallor and bilateral pitting pedal edema. Bone marrow trasplant His respiratory-, cardiac-, abdominal- and neurological examination was within normal limits. How does a bone marrow transplant work for the donor Laboratory examination showed hemoglobin of 7.2 g/dL (normal 11.5–16.5), platelet count of 22 ? 10 9/L (normal 150–500), white cell count of 3.2 ? 10 9/L (normal 4.3–10.8) with neutrophils 65%, lymphocyte 32%, and monocyte of 3%. Bone marrow transplant surgery His glycated hemoglobin was 5.6% (normal <6.5%) and liver function test revealed albumin of 2.2 g/dL (normal 3.5–5 g/dL). Bone marrow transplant donor process Rest of the biochemical investigations were within normal limits. Bone marrow aspirate injection HIV serology was negative. Bone marrow transplant procedure donor Even though, the patient had normal blood picture and reticulocyte count, bone marrow study was done for his leukopenia.

Chest X-ray posteroanterior (PA) view revealed increased bronchovascular markings [Figure 1]a and computed tomography (CT) thorax with abdomen [Figure 1]b showed bilateral mild pleural effusion with significant mediastinal and abdominal adenopathy. Bone marrow donation risks Ultrasound chest was done and it revealed minimal pleural effusion and the same was not tappable. Bone marrow aspiration test CT-guided fine-needle aspiration was done from paraaortic lymph nodes. Bone marrow transplant sickle cell Histopathology from bone marrow and cytology of paraaortic lymph nodes showed caseous necrotic granulomatous inflammation suggestive of TB. How to register for bone marrow donation Acid-fast culture of bone marrow tissue and lymph node aspirate revealed growth of pansensitive mycobacterium TB. Bone marrow aspiration dog He was initiated on modified antitubercular treatment for his kidney disease and the regimen included rifampicin 450 mg daily, isoniazid 300 mg daily, ethambutol 800 mg thrice weekly, and pyrazinamide 1250 mg thrice weekly.

Figure 1: (a) Chest X-ray posteroanterior view showing increased bronchovascular prominence, (b) computed tomography thorax showing bilateral mild pleural effusion (black arrows) with significant mediastinal adenopathy (white arrows)

Six weeks postantitubercular treatment, he came to our casualty with complaints of fever and exertional breathlessness. What is the purpose of bone marrow Patient was febrile (38.6°C) with respiratory rate of 32/min, pulse rate of 120/mine, blood pressure of 150/92 mm of Hg, and oxygen saturation of 92% at room air. Bone marrow location Respiratory examination was suggestive of right pleural effusion. Yellow bone marrow is located in the Rest of the examination was within normal limits. Treatment for bone marrow cancer Chest X-ray PA view showed features suggestive of right moderate to massive pleural effusion [Figure 2]a. Where is the bone marrow located Diagnostic thoracocentesis revealed milky white fluid and analysis showed total protein 4.1 g/dL, glucose 117 mg/dL, total cholesterol 68 mg/dL, triglycerides 751 mg/dL, and chylomicrons 1050 mg/dL. Register as a bone marrow donor Cytology of the pleural fluid was negative for malignant cells, cultures for bacteria and mycobacteria were negative. Contraindications of bone marrow aspiration Hence, a diagnosis of chylothorax was made. Can i be a bone marrow donor Repeat CT thorax with abdomen showed an increase in the size of mediastinal and abdominal lymphadenopathy. What is meant by bone marrow Hence, the acute worsening in patient clinical condition was attributed to be part of PR/IRIS, developing secondary to antitubercular treatment. Can i donate bone marrow His antitubercular therapy was continued and was managed symptomatically with parenteral nutrition, therapeutic thoracocentesis, antipyretics, and oxygen; nonsteroidal anti-inflammatory drugs were deferred in view of renal disease. Bone marrow operation Despite these he was symptomatic, so initiated on tab prednisolone 1 mg/kg/day. Bone marrow transplant test In view of persisting breathing difficulty, increasing oxygen requirement and worsening pleural effusion radiologically after informed consent intercostal drain (ICD) was inserted. Bone marrow transplant hospitals Post-ICD X-ray showed partial expansion of lung, so patient was connected to ?20 cm water suction. Tissue type associated with red bone marrow Despite these lung failed to expand, thoracic surgery opinion was obtained and he underwent decortication and interruption of the thoracic duct. Bone marrow diseases list Histopathology of the operated specimen showed fibrous connective tissue, fibrinous, and acute inflammatory exudates. Bone marrow transplant indications Postoperative chest X-ray showed good lung expansion and resolution of right pleural effusion [Figure 2]b. Process of bone marrow donation Prednisolone 1 mg/kg daily was continued for 2 weeks, then, it was tapered to 0.5 mg/kg and the same was given for 2 more weeks. What type of tissue is bone marrow The patient was discharged on antitubercular treatment and was advised to continue the same for total of 6 months. Bone marrow biopsy sedation On follow-up, patient showed good clinical recovery.

Figure 2: (a) Chest X-ray posteroanterior view post 6 weeks of antitubercular treatment showing moderate to massive right pleural effusion, (b) postsurgery chest X-ray posteroanterior view depicting resolving right pleural effusion

Paradoxical deterioration during anti-TB therapy defined as the radiological or clinical worsening of preexisting lesions or the development of new lesions in a patient who initially improves with anti-TB therapy. Bone marrow infection TB and HIV both cause immune dysfunction. Types of bone marrow TB is associated with depressed cellular immunity and other immunological abnormalities, which are restored to normal by effective anti-TB therapy. Cost of bone marrow transplant Hence, there is sudden shift of host immunity from an anti-inflammatory and immunosuppressive state toward a proinflammatory state. Bone marrow makes blood Poor drug compliance, the progression of the original disease, drug resistance, and other secondary diagnoses should be ruled out before diagnosing IRIS. Register for bone marrow donation The incidence, timing, and clinical spectrum of PR varies widely between studies.

The incidence of PR in HIV-negative patient varies from 2.4% [1] to 28%. What is a bone marrow [2] In one study, PR occurred in 28% of 50 HIV-positive TB patients and 10% of 50 HIV-negative TB patients. Tumor of the bone marrow medical term [2] The median time from starting TB medication to the onset of PR was 33 days in the HIV-positive tuberculous patients (range 3–173 days) and 87 days in the HIV-negative tuberculous patients (range 23–157 days). Where to buy bone marrow Baseline anemia, low albumin, lymphopenia, and a greater change in lymphocyte count were independent risk factors for developing PR. Purpose of yellow bone marrow [1] Our patient had all the three risk factors. What is a bone marrow donor Chylothorax in adults is a rare cause of pleural effusion seen in approximately 2–3% of pleural effusions can be divided in the nontraumatic cause (72%) and traumatic (28%). Indication of bone marrow aspiration Malignancy accounts for more than 50% of chylothorax diagnosis. Risks of bone marrow donation Nonmalignant etiology is separated into congenital, idiopathic, and miscellaneous. Yellow bone marrow function Miscellaneous causes include Castleman’s disease, lymphangioleiomyomatosis, [3] sarcoidosis, Kaposi sarcoma, Noonan syndrome, Yellow nail syndrome, TB, [4] Down syndrome, congenital lymphangiectasia, Waldenstrom macroglobulinemia, filariasis, thoracic irradiation, subclavian vein thrombosis, constrictive pericarditis, and cirrhosis. What is the purpose of red bone marrow [5]

Pulmonary TB as a cause of chylothorax etiology was rare; with only a few cases reported in the world literature. Bone marrow transplant registry [6], [7] Chylothorax is a rare manifestation of TB-associated PR in HIV-positive patients. Bone marrow transplant risks donor To the best of our knowledge, PR presenting as chylothorax in HIV-negative patients is extremely rare and no cases reported till now.

In our patient, the cause for chylothorax possibly due to the mediastinal lymphadenopathy, which obstructed the thoracic duct flow and resulted in chyle leak into the pleural space. Reasons for bone marrow transplant The administration of corticosteroid did not halt the progressive increase in chylous pleural effusion in our patient. What makes bone marrow To the best of our knowledge, we are the first to report a case of chylothorax due to PR in non-HIV tuberculous patient. Anemia bone marrow There was no evidence/case report to suggest that chronic renal failure is a risk factor for IRIS, just like HIV. How to be bone marrow donor This case illustrates the variable manifestations of TB-associated IRIS and suggests that close monitoring of clinical response.

Geri G, Passeron A, Heym B, Arlet JB, Pouchot J, Capron L, et al. Bone marrow and red blood cells Paradoxical reactions during treatment of tuberculosis with extrapulmonary manifestations in HIV-negative patients. No bone marrow Infection 2013;41:537-43.

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