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삼성서울병원 차민재

2015 년 11 월 흉영 월례집담회. 삼성서울병원 차민재. Case 1. M/69 C.C: Dyspnea, General weakness P.Hx : HTN/DM/Hepatitis/TB (+/+/-/-) COPD BP: 113/71 (mmHg ), PR: 110 (/min ), RR: 22 (/min ), BT: 36.7 (˚C ). 2015-03-20. Tx : 3rd cepha + macrolide  tazolactam + ciprofloxacin. 2015-04-02.

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삼성서울병원 차민재

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  1. 2015년 11월 흉영월례집담회 삼성서울병원차민재

  2. Case 1 M/69 C.C: Dyspnea, General weakness P.Hx: HTN/DM/Hepatitis/TB (+/+/-/-) COPD BP:113/71 (mmHg), PR:110 (/min), RR:22 (/min), BT: 36.7 (˚C)

  3. 2015-03-20 Tx: 3rd cepha + macrolide  tazolactam + ciprofloxacin

  4. 2015-04-02

  5. 2015-04-02

  6. 2015-04-02

  7. Clinical course • Pleural effusion analysis • Polymorphonuclearleukocytes dominant exudate • Glucose 150 ADA 20 • Culture (-), Fungus culture (-), AFB (-) • Leukocytosis, elevated ESR (47 mm/hr) and CRP (9.6 mg/dl) • Prolonged general weakness and fatigue

  8. Clinical course • Volume expanding pneumonia? -- Klebsiella? Pseudomonas? • Nocardiosis? • Lung cancer (adenocarcinoma)?

  9. 2015-04-06

  10. bronchoscopy LLL RLL

  11. EBUS-Guided Bx.

  12. -- Suppurative and necrotizing inflammation -- No evidence of malignancy (4R, 7 LN: no evidence of malignancy) -- AFB : No positive microorganism identified

  13. GMS stain: reveals microorganism, probably bacilli

  14. Isolate : #01 Organism : Unidentified Gram positive bacilli (branched) Highly suspicious for Nocardia species

  15. Final report

  16. 2015-04-13 AP 2015-05-11 PA TMP-SMX (bactrim), 1 mon

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