|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 28
A case of disseminated tuberculosis presenting as acute lung injury vol. 2 issues 2, 2014
Vikas T Talreja
Department of Medicine, Dr. Ram Manohar Lohia Hospital, New Delhi, India
|Date of Web Publication||12-Dec-2014|
Vikas T Talreja
GH 13, Flat No. 886, Paschim Vihar, New Delhi 110 087
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Talreja VT. A case of disseminated tuberculosis presenting as acute lung injury vol. 2 issues 2, 2014
. J Assoc Chest Physicians 2015;3:28
Subject: With reference to your case report published in your respected journal in vol. 2 issue 2, 2014 quoting "Disseminated tuberculosis presenting as acute lung injury (ALI)."
At the outset, I would like to congratulate the authors for illuminating us with the topic of most prevalent great masquerader disease of India that is, tuberculosis and its remarkable, unique presentations. Even though you have presented your case in a simple, lucid and elegant way yet human brain is accustomed to ask certain fallacies to my best of the abilities.
- I would like to know why disseminated tuberculosis was kept as the final diagnosis as only pulmonary system was involved and to my best of the knowledge disseminated tuberculosis is defined by isolation of Mycobacterium tuberculosis from blood or bone marrow, from a liver biopsy specimen, or from specimens from two or more noncontiguous organs in a single patient 
- Patient was given steroids at the time of admission and discharge. Can you rationalize steroid use at the time of admission and discharge of the patient as the patient was never in septic shock or addisonian crisis 
- Even though echocardiography was done, however biomarker tests like troponins T/I cannot be replaced for the possibility of acute cardiogenic pulmonary edema
- I would also like to know why patient was treated as ALI as the initial diagnosis as ALI/acute respiratory distress syndrome can be justified on chest X-ray only when there is sparing of costophrenic angles by infiltrates as opposed to this patient where they were predominantly involved
- Even though I understand the inadequacy of facilities and overburdened health care in developing countries like India, this patient had fever of 1-month at the time of diagnosis concluding she was a case of pyrexia of unknown origin. Hence, some of the test such as Brucella More Details serology's, bone marrow aspirate, fungal serology, and cultures and anti-ds DNA antibody was necessary
- Even though, remote yet the possibility of reactivation of tuberculosis or acquiring of tuberculosis in the period she was lost to follow-up was justified as she was on immunosuppressive therapy. Hence, postmortem biopsy cannot rule out whether the initial presentation was of tuberculosis or not.
It is my humble request not to argue, but to discuss common fallacies of common diseases and bring author's notice to these minute details which do have a significant role in our day care medical practices.
Looking forward with anticipation,
Dr. Vikas. T. Talreja
| References|| |
Iscman MD. Extra pulmonary tuberculosis in adults. In: Iseman MD, editor. A Clinician's Guide to Tuberculosis. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 145-97.
Peter JV, John P, Graham PL, Moran JL, George IA, Bersten A. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: Meta-analysis. BMJ 2008;336:1006-9.