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Passport data

Name: Bryushinina Dariya IgorievnaGender: femaleAge: 9 years old (20.10.2004)

Date of admission: 08.08.2013Clinical diagnosis: Tuberculosis of intrathoracic lymph node in phaseconsolidation and calcification. Mycobacterim

ComplaintsAt the time of admission: decreased of appetites . At the time of Supervision:no complaints.

Anamnesis MorbiContact with her sick mother. Her mother receives an outpatient treatment.Patient did not vaccinate with BCG. Primary tuberculosis infection in 2009,

Mantoux test was 14mm.History of Mantoux test:2006-2008; negative2009- 14mm2010-15mm2011- 13mm2012-13mm2013-18mm (hypergic)

Life historySecond child from 9th pregnancy. Pregnancy was full term. Birth weight

3100gr. Did not received breastfeeding Growth and development areaccording to their ages. Patient had history of frequent viral respiratoryinfections, chicken pox. Her Mother is suffers from tuberculosis and AIDSAllergic reactions: no.Hereditary disease-absent.Blood transfusion-absent.Injuries and surgeries- absent.Vaccinations- did not receive BCG.Epidemiological. history: lives in a comfortable one-bedroom apartment. Thefamily of 3 persons: 1 child, mother and father.

Status Presents

Habitus: Good, patient is calm, conscious, alert with surrounding, nofever(36.5C), edema on both legs, mucous membrane pinkish normal, skinnormal, extremities normal, no ulcer, hypersthenic constituents, lymphnodes are not enlarged, skeletal-muscular system without pathology.

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Cardiovascular system:Pulse-78bpmBp-110/70Auscultation-dual, rhythm, no murmurPercussion-normal heart border

Palpation-apex beat is at 5th intercostals space midclavicular line.* Respiratory system:Auscultation - vesicular breathing, no adventitious sound.Percussion - symmetrical, normal lungs borders.When topographic percussion:

Lower BoundsLINE RIGHT LEFTparasternalis 4

intercostal/spac

e

-

medioclavicularis

5intercostal/space

-

axilarisanterior

6intercostal/space

6intercostal/space

axilarismedia

7intercostal/space

7intercostal/space

axilaris

posterior

8

intercostal/space

8

intercostal/space

scapularis 9intercostal/space

9intercostal/space

paravertebralis

10intercostal/space

intercostal/space

* Nervous system: Glasgow coma scale, GCS score 15. Patient is consciousand calm.

* Urinary system: urine output normal.Pasternatskys symptom(palpation on ilioinguinal region): negative* Hemopoietic system: no enlargement of superficial lymph nodes on neck.* Endocrine system: thyroid gland is not palpable.* Digestive system:Normal pinkish mucous membrane, tongue is pink.Percussion-normal liver borders

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Palpation: prelium line without protrusion, palpatable stomach, ascendingdescending sigmoid colon, and liver. Unpalpatable spleen, gallbladder andpancreas, on palpation, the epigastric region is slightly hardened.

Labaratory Analysis

Blood analysis

Erythrocytes-33.9x10 9/literHemoglobin- 120g/literColour index-0.91Leucocyte : 5.6 x 10^9Eusonophils-7Segmented form : 34Band orm-8Lymphocyte : 27Monocyte : 5ESR= 3 mm/h

Urine AnalysisQuantity : 50.0Reaction : acidicColour : clearSpecific gravity : 1013Protein : 0.17No of leukocyte per visual field : 0No of fresh RBC per visual field : 0

Liver Function test

Total bilirubin 5.5mmol/lALT-0.13AST-0.07Timolova test- 5.8

Sputum Analysis MBT

Tuberculin skin testHistory of Mantoux test:2006-2008; negative2009- 14mm2010-15mm2011- 13mm2012-13mm

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2013-18mm (hypergic)

Dia Skin test21/6/2013- 21mm20/8/2013-15mm

Chest X-rayNo focal inflammation on both lung. Shadow of right root lung is extendmore than 4 ribs, the outside countour is dim, the structure is bluured andintensity is increased. Shadow of enlarged lymph node of bronchopulmonarygroup of right root lung is clearly seen on tomogram. Present calcification ofright lung.Impression- tuberculosis intrathoracic lymph node in phase of consolidation

and calcification.

Clinical Diagnosis

By analyzing and comparing the data of complaints (slightintoxication: decrease appetide), medical history: contact with sick mother,absent BCG vaccination.X-ray - clear lung fields, relative to the structure.Defined and enlargedlymph nodes bronchopulmonary groups, and calcification on left lung.Clinical examinations- relative neutrophilia, lymphopenia, which is typicalfor primary tuberculosis;And on the basis of the findings put a final diagnosis:Tuberculosis ofintrathoracic lymph node in phase consolidation and calcification.Mycobacterim

Differential Diagnosis

Tuberculosis of intrathoracic lymph nodes must be differentiated from thepathological changes in the mediastinal and hilar. Mediastinal tumor-like lesions,nonspecific adenopathy, vascular malformations of the chest cavity. Distinguishthese diseases can be the fact that negative result in tuberculin test. Also can bedistinguished from the thymus hyperplasia, thymomas: their distinctivecharacteristic is that in these pathologies revealed signs of compression in themediastinum and hormonal variations that are not found in tuberculosis.

Tuberculosis must be differentiated from adenomas: Hodgkin's disease. The

difference is negative tuberculin skin test, even if they previously were positive,due to reduced immuni. And the need to differentiate from lymphocyticleukemia. The difference: In blood found leukemia blast cells, and a negativereaction to tuberculin.

Treatment

I :1. Isoniazid 0.15 mg x 1 per day

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2. Rifampicin 0.15 mg x 1 per day3. P yrazinamide 0,375 mg x 1 per day4. Vitamin B6 0.015mg/day5. Polyvitamins

Duration of treatment-6 months

Diary29.09.13. Body Temperature is 36.5 C, heart rate 85 beats / min.respiratory rate 22/min. The condition is satisfactory, active. Complain ofDecrease appetite. The skin is clean, soft.

02.10.2012. Body Temperature is 36.5 C, heart rate 85 beats / min.respiratory rate 20/min. The condition is satisfactory, active. Complain ofDecrease appetite. The skin is clean, soft .

Prognosis- Good.

VOLGOGRAD STATE MEDICAL

UNIVERSITY

Department of

Phtysiopulmonology

CLINICAL CASE HISTORY

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Patients name: : Bryushinina Dariya Igorievna

Clinical diagnosis: Tuberculosis of intrathoracic lymph node inphase consolidation and calcification. Mycobacterim

By:Nur Atikah Mohd Jamil

Group No. 33

Supervised by:N. L. Popkova