INH INDUCED GYNAECOMASTIA

A 45 year old male,being treated for tubercular pleural effusion since last 4months, presented with the complaint of mild swelling and pain over both nipple and areolar region. He was non diabetic and his liver and kidney functions were within normal limits.He took INH,rifampicin,ethambutol and pyrazinamide for the first 2 months and was currently on INH and rifampicin.He was diagnosed as a case of drug induced gynaecomastia and the culprit drug in this case was INH.
DISCUSSION: Gynaecomastia is hypertrophy of breast tissue in males. It is usually transient,bilateral,symmetrically distributed, It has various causes(hepatic and renal failure/endocrine disorders/drugs). Two antitubercular drugs can cause gynaecomastia- INH and ethionamide. Here we have to continue INH for 2 more months. Meanwhile we need to reassure the patient that the disorder is transient and will recover once INH is stopped.

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PULMONARY TUBERCULOSIS PRESENTING LIKE LOBAR PNEUMONIA

A 50 year old male presented with dry cough since 3months, irregular fever since 20 days,left anterior chest pain since 3-4 days. He was non hypertensive and non diabetic. His TLC was 9300;60%neutrophils,38%lymphocytes and 2%eosinophils.SPUTUM for AFB was negative for 3 consequetive days and MT was negative.His chest xray showed left mid zone consolidation.He was given cefuroxime500 bd for 7 days and there was no improvement in symptoms.

His sputum pyogenic culture was negative but sputum culture by BACTEC method yielded mycobacteria. He responded very well to 6 months antitubercular therapy and was asymptomatic at the end of treatment.

clinical pearls: Here pulmonary tuberculosis presented like lobar pneumonia and chest pain was the aggravating symptom which brought the patient to the doctor.

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AZATHIOPRINE INDUCED MYELOSUPPRESSION

A 24 years old male presented with exertional shortness of breath since 10-15days. He was a diagnosed case of crohn's disease and was taking mesalazine since last 4 years and azathioprine since last 6 months.On clinical examination the only positive findings were severe pallor and mild icterus. His investigations revealed hb-4.5gm/dl, TLC2600,platelet count180000.His peripheral blood film,liver function and kidney function tests were normal. 6months back before starting azathioprine his blood reports were hb-10.5gm/dl, TLC-8400 and platelet 429000. we diagnosed the case as azathioprine induced myelosuppression and stopped the drug immediately. He is still under follow up and his further reports will confirm our diagnosis.

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PNEUMONIA WITH ATYPICAL PRESENTATION

A fifty year old diabetic hypetensive male,presented with mild fever since one day,chest discomfort and restlessness since last 1 hour.His BP was 140/80,pulse100/min,respiratory rate was 28/min,afebrile at the time of examination.His spo2 was66%.his resting ecg was normal and chest xray showed a dense right upper lobe consolidation.TLC was 24400,90% were neutrophils and random blood sugar was 251.his sputum for AFB was negative and gram stain revealed gram positive cocci in chains.
CLINICAL PEARLS:This is acase of lobar pneumonia with atypical presentation.Diabetes is responsible for such altered appearance of the disease.The patient deteriorated rapidly without any prior warning signs or symptoms.So one has to be very careful while dealing with a diabetic pneumonia.
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