Concluded Case

26yr old female came to opd with c/o dyspnoea on exertion,nasal congestion,headache ear block off and on.H/o similar complaints last yr in same winter season. blood reports TLC 17000 eosinophils 55 '/. AEC 1300 O/E B/L wheeze (minimal) B/L turbinate hypertrophy. we came to a diagnosis of tropical pulmonary eosinophilia (TPE) treated patients with itracinazole 200 for 14days mometasone nasal spray and anti histamines. PT feels good now. ur expert comments on the case pls!!!

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Concluded answer

Clinicoradiologicaly looks like ABPA. Adv IgE level, AEC, aspergillus specific antibodies IgM. Hetrazan, antifungals with steroid combination. Adv CECT thorax to rule out bronchiectatic lesions. Also needs Echo CD.

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Fibrocavitary lesions on both midzones. PTB.

It's a case Case of Pulmonary Eiosinophilia, Do CBNATT, rule out plueral effusion, CXR P/A shows hyperinflated with bilateral & mid Haziness, Ddx, COPD, LRTI,Pneumonitis Do HRCT chest & PFT, QFT

Thanx Dr. Pushker Bhomia Sir Ji
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Chest is emphysematous Xray chest shows bilateral floppy swellins in lower zones Rest of lung fields are hyperinflated Hemogram suggest leucocytosis and eosinophilia 55% with aec 1300 looks to be unjustified Floppy swellings is secondary pneumonitis as leucocytosis suggest Do you suspected fungal aetiology to treat with itracanazole rather than hetrazan it is my concern Wheezing suggest obstructive presentation My suggestion is inj Ceftriaxozone +bronchodilators like deriphylline or aminophyline with inj dexamethasone Oral hetrazan 200mg 1tds So far nasal congestion and ear blocks are concerned are due to hypertrophied turbinates get more congested due to allergic factor I will suggest for PNS view to r/o any polyps and DNS

Thanx dr Ajeet Singh
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Mild pneumonia

RIGHT COSTOPHRENIC ANGLE OBLITERATED PLEASE RULE OUT MINIMAL PLEURAL EFUSSION

Good that patient improved. Properly managed by you, But HRCT might be useful tool. Can start Hetrazan initially before Itraconazole.

Rt mid cavitory lesion do cbnat leucocytosis with eosinophilia with cold do total eosinphilic count more then 500 then hetrazan100 tds 21 days hrct basal rt pleuritic pneumonitis

Bil mid and basal heziness seen. Nodular opacities with in it noted. Prominent Pulmonary arteries seen. Evaluate and treat for secondary infection.

Aec more then 1000 , so rule out ABPA, tpe as pat is having recurrent asthma....adv for ct chest to rule out bronchiectatic changes...and in view of TPE. DOC is heterazen for 1 month.. if refractory to heterazen then go for itraconazole... after CT , plan for s.IGE and IgG specific for aspergillus, and also skin prick test..

Case of Eiosinophlia

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