Image Challenge 19

September 1, 20091comments

The patient is a 21 year-old college student presents to a local hospital with a 3-week history of fever with occasional chills, headache, myalgia, pleuritic chest pain, and nonproductive cough. He denied shortness of breath, but lost 10 lb over the past month. He reported no night sweats, or blood in his sputum. There were no known exposures to tuberculosis, but on further questioning he revealed that he had traveled extensively during the summer break. He spent the summer backpacking through the states of Ohio, Kentucky, Indiana, Illinois, and Missouri, and when he needed to earn additional spending money, he worked at construction sites. On physical exam (PE) he had a temperature of 38C (100.4F), pulse 126 beats/min, respirations 30 breaths/min, and blood pressure 110/70 mm Hg. He was well-appearing and in no acute distress but complained of intense fatigue. Chest exam revealed bilateral inspiratory pulmonary crackles. The remainder of his PE was within normal limits. A chest x-ray demonstrated bilateral patchy, nodular infiltrates and hilar lymphadenopathy.
Based on the clinical symptoms and X – Ray, what microbiological tests you suggest?
What is your diagnosis?
Comment your answers in the comment section before 01 Oct 2009.
First two correct entries will be rewarded with a surprise gift.
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January 12, 2010 at 12:26 AM

miliary tb

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