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A.G. Holley Hospital
Case
Histories
Case 3
The patient is a 37 year old Asian female who originally presented to her primary care
md 2 years earlier with c/o cough. A ppd was done which was positive at 20mm. A cxr showed
a rul 3 cm nodule. The pt was told that tb should be r/o. The pt’s husband became
angry and they went to see a pulmonologist.Two years later the pt returned to her
primary care md with the same c/o but this time she was coughing up blood. Arrangements
were made to have the pt im. The pts husband became extremely upset that tb was mentioned
again and stated that tb was impossible since he and his wife had received bcg. The pt and
the family went into hiding. Note from pulm.Pmh-allergic rhinitis. Meds-decongestants and
nasal steroids.
Social hx-born in china, in us almost 10 years with travel to china. Volunteered at
school and was a homemaker with two kids. Husband was professor at a major university.
Case reported to health dept and a court order was obtained after extensive and exhaustive
efforts were made to have pt be evaluated voluntarily. Husband paranoid. Sheriff's office
involved but pt could not be located. After Pt finally gave sputum in california to sister
who worked at a med school. 2+afb on smear. Court-ordered tx in california. Husband had an
abnml cxr with +cx. Both children infected without disease.
Suspect and pursue the diagnosis of tb in patients with chronic respiratory symptoms
and who fall into high risk categories. State law mandates that patients confirmed or
highly suspected of having active tb be treated and/or isolated until cure.
Cultural factors may pose barriers to treatment. Dna matched in both adults. Two weeks
pt surfaced in California. Had md degree from China. Stated that ppd and cxr abnml was
from bcg.
Mediately evaluated in the hospital to r/o tb.
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