What's the Diagnosis? By Dr. Michael Tom

A 53 yo M w/ a remote history of TB, prior IVDU and hepatitis C presents to the ED with cough and intermittent hemoptysis. He reports associated fever, night sweats and malaise. A CXR is obtained. What's the diagnosis? (scroll down for answer)


Answer: Reactiviation TB

  • Reactivation TB represents 90% of active TB cases in the immunocompromised population
  • Patients typically present with B symptoms (fever, night sweats, weight loss) and cough with or without hemoptysis
  • CXR may show: patchy or lobar consolidation, cavitation (typically in postprimary TB), hilar and mediastinal adenopathy, or pleural effusions
  • Reactivation TB typically develops in the posterior upper lobes or the superior lower lobes
  • ED patients with suspected TB should have PPD, sputum AFB smear/culture and HIV testing
  • Patient should be placed in isolation with airborne precautions in a negative pressure room
  • Initial treatment regimen includes 4 drug therapy for 8 weeks: rifampin, isoniazid, pryazinamide and ethambutol