LUNG CANCER COMMUNITY
tuberculosis or lung cancer

tuberculosis or lung cancer

I accompanied my father to the hospital after a few days of intermittent fever.  He is 69 yo, has COPD and had stopped smoking a few years now. We had some labs done and he showed infection.  He also had a cxr and it showed a lobulated density in the right middle lung field with surrounding hazy infiltrates.  A wedge shaped opacity is likewise seen in the right middle lung field.  We went to a pulmo and he gave my father cefuroxime axetil and augmentin for a week.  after which he was then again given 2g augmentin for another week and rimactazid for 10 days.  The fever still persisted but duration between fevers improved. My father is taking paracetamol to manage fever of 38 to 38.6 degrees.Follow up chest radiograph (pa and lateral) showed increase in degree of the right middle lung field atelectasis with deviation of the minor fissure and compensatory  hyper inflation of the right lower lung.  Bilateral pulmonary hyperaeration is again observed.  We were advised to get a biopsy.  While in the hospital my father was given ertapenem.  His cbc stilled showed infection from the previous 15.5 to 11.9.  CT scan showed a large lobulated density with interspread areas of necrosis measuring approximately 10cm x 9cm(greatest anterioposterior and transverse dimensions respectively) is seen in the right perihilar area.  Extensive fibronodular densities surrounding this lesion is also present.  A 3.5 cm enlarged lymph node is detected in the right peretracheal area.  There is also a thin-walled lucency devoid of lung markings in the medial segment of the right middle lobe measuring approximately 5.0x4.5 cm in its greatest anterioposterior and transverse dimensions.  The impression is a large perihilar mass with enlarge pretracheal lymph node,as described.  Finding is likely a neoplastic process however koch's infection is a possibility due to the fibronodular densities in the right upper lobe which is consistent with concomitant koch's infection. As for the fine needle aspiration cytology and cell block,specimen limited to mainly red blood cells,neutrophils and necrotic debris.  Smears and cell block show predominantly red blood cells with numerous polymorphous leucocytes,occasional foamy macrophages,some necrotic debris and fibrin-like material.  No definite granuloma or multinucleated cells are seen and no atypical cells are seen in the aspirate.  Gross microscopic description: received is approximately 0.6ml of bloody abd non-viscous aspirate for examination after three passes.  prepared seven smears,two air-dried stained with diff-quick and five alcohol-fixed stained with modified papanicolaou's reagent.  One cell block is processed.  Same specimen was sent for TB REAL TIME PCR GENO TYPING and result showed positive for M. tuberculosis. Same specimen was also sent for AFB and bacteriology but both reported no microorganism seen. They say RT PCR GENO TYPING is best for determining TB. We also did a sputum exam and showed heavy growth of enterobacter cloacae. Going back to our pulmo, my father was given cefepime on IV for 8 days and now on oral ciprofloxacin for another week.  My father was also given TB medication Myrin p forte, 3 tablets before breakfast and IM shots of streptomycin twice a week.We are on our 16th day on myrin forte.The fever is still there.  When will the symptoms of TB ie fever, chills,loss of appetite go away?  Our pulmo is still thinking there is malignancy even all tests showed otherwise.  We Hope it is not.  What are your thoughts?  Thanks for the help and sorry for the long post.
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