A case of Multiple lung cavities

32 year old male patient presnted to opd with history of

Hemoptysis ,loss of appetite and cough 5 years back and daignosed as Pulmonary tuberculosis  for which he used Antitubercular therapy for 4 months and discontinued .

Patient was apparently assymoptomatic 3 months back then he developed weakness of both lower limbs ,that gradually progressed to a state ,where he couldn't get up from bed and do his daily routine activites .No bowel and bladder involved and .? AIDP .He was admitted in a hospital ,where supportive care was given and he recovered within 2 months .

Patient also reports to be having fever - of high grade with chills ,present daily and was more during night times .

He complaints of dry cough , associated with left sided chest pain - dragging type ,non radiating and increasing on inspiration and on coughing .

He complaints of shortness of breath - on climbing stairs and on exertion - MMRC grade 1 .

He also gives significant history of weight loss and loss of appetite .

no history of hemoptysis

Past history:

H/O koch's 5 years back,used ATT for 4 months and stopped.

H/O multiple suicide attempts present. 

Not a k/c/o DM,HTN,asthma,epilepsy,CAD.

Personal history :

Diet-mixed

Appetite-lost 

Sleep-adequate 

Bowel and bladder movements-regular

Alcoholic, stopped 1 and half year back

Smoking 1 pack/ day

General examination:

Patient is malnourished ,thin built and lethargic .

Vitals on admission:

Temperature-98.8 F

BP-100/80mmhg

PR-88 bpm

RR-17 cpm: 

Systemic examination:

Respiratory system examination : 

CNS 

Rightt left

Power

Upper limb 5/5 5/5

Lower limb 3/5 3/5

Reflexes 

Biceps +2 +2

Triceps - -

Supinator - -

Knee - -

Ankle - -

Plantar flexor extensor

Thenar muscle atrophy present 

Provisional daignosis : 

Pulmonary Tuberculosis 

History of  paraplegia 

Investigations:

In view of Strong suspicion of Tuberculosis sputum for AFB and CBNAAT were sent 

Sputum ZN stain showed multiple rod shaped bacilli - suggestive of Tuberculosis 

CXR PA view showed - Bilateral multiple lung cavities -more on left apical region 

Sputum CBNAAT showed Rifampicin sensitive tuberculosis .

We started him on ATT drugs and asked to review to opd for further follow up.