Lung & Respiratory Diseases

Biography

Biography: Jason C. Romero M.D.

Abstract

We are presented with a 60 female of Asian descent with unremarkable PMHX & FMX, complaining of upper back pain with right upper arm pain and weakness for a month treated. A Week prior to admission, progression of weakness, numbness with right sided hemiplegia but with no constitutional symptoms seek consult and was admitted. On work up, CBC, urinalysis, electrolytes, lipid profile, BUA, amylase, lipase, liver, kidney, CK enzymes, Troponin I, Cranial CT scan, sputum GS/CS and AFB where all unremarkable. CXR- revealed bibasal pneumonia and Throracolumbar xray- compression fracture at T6.  Antibiotic, steroid and pain medication was started, Chest CT scan with contrast revealed area of consolidation in the superior segment of the right lower lobe suspicious for broncho-alveolar new growth severely compressing the T6 fracture. An initial diagnosis of pathologic compression vs Potts infection was entertained. She was referred to Orthopedic service and interventional radiology service where MRI thoracic spine with contrast revealed compression fracture T5, T6 and T7. CT scan guided biopsy was done revealing pathology highly suggestive of chronic granulomatous inflammation. Slight improvement with antibiotic, steroids and pain medications hence bronchoscopy with bronchial washing and biopsy was done revealing reactive respiratory epithelium and chronic inflammation with no evidence of malignancy. Anti koch’s regimen was started prompting a drastic improvement on her symptoms and was eventually discharged. History taking, with good physical examination, guided by diagnostics are the key component in proper diagnosis and treatment specially in our country where Tuberculosis is rampant.