PULMONARY TUBERCULOSIS WITH NORMAL CHEST XRAY

A 25 year old male presented with high grade intermittent fever with dry cough since 10 days.There was no significant joint pains and bladder and bowel habbits was normal.He was treated with ofloxacin and cefixime for 5 days with no relief in fever.His lab reports were TLC8400,n70,l29,e1%,ESR45,MP,optimal,dengue igm-ve.widal test was -ve and urine RE was within normal limits.LFT was a bit deranged- total bilirubin was 4.2,sgpt152u\l,sgot104u\l..His chest xrays were apparently normal.His usg abdomen showed mild hepatomegaly.Considering cough as a prominent symptom,we did a CT scan of chest.The scan showed bilateral patchy pulmonary infiltrates.His sputum,which was mostly serous did not reveal any AFB.He was treated with inh,ethambutol and streptomycin(altered ATD regime due to deranged LFT).His fever subsided in 2 days and did not return again.
CLINICAL PEARLS: always search for tuberculosis in a patient with pyrexia of unknown origin
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