Antibiotic-resistant cough and pneumonia

Colas TCHERAKIAN, Department of Pulmonology, Foch Hospital, Suresnes; Immune Deficiency Competence Center; Eosinophil Reference Center (CEREO)

79-year-old patient with a history of well-controlled asthma on inhalation therapy.

No other treatment. Occurrence of breathing difficulties in December 2021. Start of antibiotic therapy with amoxicillin-clavulanic acid on January 14th. with basal pneumopathy on the right. On 01/28 Bouts of fever at 40°C, sweating, anorexia and loss of 3 kg in 4 days. Discontinuation of amoxicillin-clavulanic acid on March 1st. (Total duration 1.5 months). Persistent wet cough with sputum, exertional dyspnoea, biological inflammatory syndrome (CRP 34 mg/L). Because of the lack of improvement on 16.03. consulted in the emergency room Foch. Current vaccinations (Covid x 3, pneumococci 2019 and flu 2021). No trips outside of France. Clinical examination reveals no distinctive element other than a diminished vesicular murmur in the right base. Biology finds a CRP at 65 mg/L without hyperleukocytosis. Legionella and pneumococcal antigenuria are negative. What’s your diagnosis? Our fibroscopist Geneviève Le Bourdellès made the diagnosis at the endobronchial level. This is endobronchial tuberculosis. The lesion of the trachea is characteristic. This, of course, explains the picture of antibiotic resistance. This form is usually very contagious. There is also a high risk of stenosis, which merits corticosteroid therapy and progressive endobronchial control. In the reconstruction, an aspect of peribronchial inflammation and sheathing is observed. Auscultation also found a drop in vesicle noise and no crackling! What’s your diagnosis? Our fibroscopist Geneviève Le Bourdellès made the diagnosis at the endobronchial level. This is endobronchial tuberculosis. The lesion of the trachea is characteristic. This, of course, explains the picture of antibiotic resistance. This form is usually very contagious. There is also a high risk of stenosis, which merits corticosteroid therapy and progressive endobronchial control. In the reconstruction, an aspect of peribronchial inflammation and sheathing is observed. Auscultation also found a drop in vesicle noise and no crackling! Posted in Takeover Practice

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