Passport data Name: Bryushinina Dariya Igorievna Gender: female Age: 9 years old (20.10.2004) Date of admission: 08.08.

2013 Clinical diagnosis: Tuberculosis of intrathoracic lymph node in phase consolidation and calcification. Mycobacterim <-ve> Complaints At the time of admission: decreased of appetites . At the time of Supervision: no complaints. Anamnesis Morbi Contact with her sick mother. Her mother receives an outpatient treatment. Patient did not vaccinate with BCG. Primary tuberculosis infection in 2009, Mantoux test was 14mm. History of Mantoux test: 2006-2008; negative 2009- 14mm 2010-15mm 2011- 13mm 2012-13mm 2013-18mm (hypergic) Life history Second child from 9th pregnancy. Pregnancy was full term. Birth weight 3100gr. Did not received breastfeeding Growth and development are according to their ages. Patient had history of frequent viral respiratory infections, chicken pox. Her Mother is suffers from tuberculosis and AIDS <+> Allergic reactions: no. Hereditary disease-absent. Blood transfusion-absent. Injuries and surgeries- absent. Vaccinations- did not receive BCG. Epidemiological. history: lives in a comfortable one-bedroom apartment. The family of 3 persons: 1 child, mother and father. Status Presents Habitus: Good, patient is calm, conscious, alert with surrounding, no fever(36.5C), edema on both legs, mucous membrane pinkish normal, skin normal, extremities normal, no ulcer, hypersthenic constituents, lymph nodes are not enlarged, skeletal-muscular system without pathology.

 Cardiovascular system: Pulse-78bpm Bp-110/70 Auscultation-dual, rhythm, no murmur Percussion-normal heart border Palpation-apex beat is at 5th intercostals space midclavicular line. * Respiratory system: Auscultation - vesicular breathing, no adventitious sound. Percussion - symmetrical, normal lungs borders. When topographic percussion: Lower Bounds LINE RIGHT parasternalis 4 intercostal/spac e medioclavicul 5 aris intercostal/spac e axilaris 6 anterior intercostal/spac e axilaris 7 media intercostal/spac e axilaris 8 posterior intercostal/spac e scapularis 9 intercostal/spac e paravertebrali 10 s intercostal/spac e

LEFT 6 intercostal/spac e 7 intercostal/spac e 8 intercostal/spac e 9 intercostal/spac e intercostal/spac e

* Nervous system: Glasgow coma scale, GCS score 15. Patient is conscious and calm. * Urinary system: urine output normal. Pasternatskys symptom(palpation on ilioinguinal region): negative * Hemopoietic system: no enlargement of superficial lymph nodes on neck. * Endocrine system: thyroid gland is not palpable. * Digestive system: Normal pinkish mucous membrane, tongue is pink. Percussion-normal liver borders

Palpation: prelium line without protrusion, palpatable stomach, ascending descending sigmoid colon, and liver. Unpalpatable spleen, gallbladder and pancreas, on palpation, the epigastric region is slightly hardened. Labaratory Analysis Blood analysis Erythrocytes-33.9x109/liter Hemoglobin- 120g/liter Colour index-0.91 Leucocyte : 5.6 x 10^9 Eusonophils-7 Segmented form : 34 Band orm-8 Lymphocyte : 27 Monocyte : 5 ESR= 3 mm/h Urine Analysis Quantity : 50.0 Reaction : acidic Colour : clear Specific gravity : 1013 Protein No of leukocyte per visual field No of fresh RBC per visual field Liver Function test Total bilirubin 5.5mmol/l ALT-0.13 AST-0.07 Timolova test- 5.8 Sputum Analysis MBT <-> Tuberculin skin test History of Mantoux test: 2006-2008; negative 2009- 14mm 2010-15mm 2011- 13mm 2012-13mm

: 0.17 :0 :0

2013-18mm (hypergic) Dia Skin test 21/6/2013- 21mm 20/8/2013-15mm Chest X-ray No focal inflammation on both lung. Shadow of right root lung is extend more than 4 ribs, the outside countour is dim, the structure is bluured and intensity is increased. Shadow of enlarged lymph node of bronchopulmonary group of right root lung is clearly seen on tomogram. Present calcification of right lung. Impression- tuberculosis intrathoracic lymph node in phase of consolidation and calcification. Clinical Diagnosis By analyzing and comparing the data of complaints (slight intoxication: decrease appetide), medical history: contact with sick mother, absent BCG vaccination. X-ray - clear lung fields, relative to the structure. Defined and enlarged lymph nodes bronchopulmonary groups, and calcification on left lung. Clinical examinations- relative neutrophilia, lymphopenia, which is typical for primary tuberculosis; And on the basis of the findings put a final diagnosis: Tuberculosis of intrathoracic lymph node in phase consolidation and calcification. Mycobacterim <-ve> Differential Diagnosis
Tuberculosis of intrathoracic lymph nodes must be differentiated from the pathological changes in the mediastinal and hilar. Mediastinal tumor-like lesions, nonspecific adenopathy, vascular malformations of the chest cavity. Distinguish these diseases can be the fact that negative result in tuberculin test. Also can be distinguished from the thymus hyperplasia, thymomas: their distinctive characteristic is that in these pathologies revealed signs of compression in the mediastinum and hormonal variations that are not found in tuberculosis. Tuberculosis must be differentiated from adenomas: Hodgkin's disease. The difference is negative tuberculin skin test, even if they previously were positive, due to reduced immuni. And the need to differentiate from lymphocytic leukemia. The difference: In blood found leukemia blast cells, and a negative reaction to tuberculin.

Treatment I : 1. Isoniazid 0.15 mg x 1 per day

2. Rifampicin 0.15 mg x 1 per day 3. P yrazinamide 0,375 mg x 1 per day 4. Vitamin B6 0.015mg/day 5. Polyvitamins Duration of treatment-6 months Diary 29.09.13. Body Temperature is 36.5 C, heart rate 85 beats / min. respiratory rate 22/min. The condition is satisfactory, active. Complain of Decrease appetite. The skin is clean, soft. 02.10.2012. Body Temperature is 36.5 C, heart rate 85 beats / min. respiratory rate 20/min. The condition is satisfactory, active. Complain of Decrease appetite. The skin is clean, soft . Prognosis- Good.

VOLGOGRAD STATE MEDICAL UNIVERSITY

Department of Phtysiopulmonology

CLINICAL CASE HISTORY

Patients name: : Bryushinina Dariya Igorievna Clinical diagnosis: Tuberculosis of intrathoracic lymph node in phase consolidation and calcification. Mycobacterim <-ve>

By: Nur Atikah Mohd Jamil Group No. 33 Supervised by: N. L. Popkova