Author: Al Argan, Reem J.; Al Elq, Abdulmohsen H.
Title: Tuberculosis-associated Immune Thrombocytopenia: A Case Report Document date: 2018_8_14
ID: q9z0wb7j_6
Snippet: The patient was seen 2 weeks after discharge at the hospital's hematology clinic and was again advised for lymph node biopsy, which he again refused despite detailed explanation. His platelet count was 216 × 10 9 /L, and thus his prescription of prednisone was planned to be tapered down gradually to 20 mg daily. However, 2 weeks later (4 weeks from his discharge), he again presented to the emergency room with a 1-week history of fever, dry cough.....
Document: The patient was seen 2 weeks after discharge at the hospital's hematology clinic and was again advised for lymph node biopsy, which he again refused despite detailed explanation. His platelet count was 216 × 10 9 /L, and thus his prescription of prednisone was planned to be tapered down gradually to 20 mg daily. However, 2 weeks later (4 weeks from his discharge), he again presented to the emergency room with a 1-week history of fever, dry cough, right-sided pleuritic lower chest pain and dyspnea. On physical examination, he appeared ill and dyspneic. His vital signs were as follows: temperature, 39°C; BP, 130/70 mmHg; PR, 130/min; RR, 30/min as well as oxygen saturation 92% on room air and 96% on nasal cannula 4 L/min. Chest examination revealed reduced breathing sounds at the right lower zone with bilateral inspiratory crepitations at both lung bases. The repeated laboratory tests were significant for a platelet count of 50.0 × 10 9 /L, acute kidney injury with blood urea nitrogen (BUN), 26 (NR: 7-18 mg/dl); creatinine, 1.32 (NR: 0.6-1.2 mg/dl); sodium (Na), 130 (NR: 135-145 mg/dl) and potassium (K), 3.0 (NR: 3.5-5.5 mg/ dl). Chest X-ray revealed haziness in the right lower lobe, suggestive of pneumonic infiltration.
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