This is about 23 years old male patient Mr. S who started with Dr. Appa Rao’s treatment in April 2013.This man premorbidly well, presented with complaints of retrosternal chest discomfort since December 2012 when he was in U.K. It was mild, continuous, and occasionally worsened with respiration. One week later he developed low grade intermittent fever without chills or rigors and also had dry cough. He was treated with Amoxicillin for one week and followed by three days of Amoxyclavulinic acid. The symptoms persisted and gradually worsened over time. He had loss of appetite and loss of weight. He also had generalized weakness and fatigue. After taking treatment for 45 days in U.K he returned back to India. In India he was taken to TB hospital where his chest x-Ray revealed hilar lymphadenopathy and Mantoux test was positive and sputum for AFB was negative. On the same day ATT was started. On the 6th of February 2013 he had worsening of chest pain, and was admitted in corporate Hospital. his cardiac enzymes were elevated and his HS TROP T (Quantitative) was Positive (250.9 nglL). ECHO was suggestive of Myocarditis, and CECT done showed Mediastinal lymphadenopathy with areas of confluence of necrosis (? Koch’s). Pericardial thickening with trivial effusion and mild hepatomegaly with few calcified granuloma in the segment lV A of liver, Right Nephrolithiasis and Mild splenomegaly was noted. Symptoms slowly improved between 7-26th of February. But high grade fever recurred on 27th February. He was then taken to higher centre for further management on 11 March 2013. A repeat CT was done there which showed there are multiple necrotic mediastinal nodes, the largest being in the anterior mediastinum measuring 25x25mm. Ultrasonography of abdomen showed Hepatomegaly with few calcific foci in segment IV - probable healed granulomas. He underwent an upper gastrointestinal endosonography guided FNAC of sub carinal lymph node. Histopathological report showed necrotizing granulomalous inflammation. His lymph node FNAC was sent for Mycobacteria Culture & Sensitivity 1st Line (MGIT Auto.) And Genxpert Tb PCR which came positive for Mycobacterium tuberculosis, Rifampicin sensitive. Thus he was diagnosed with Disseminated Tuberculosis, Tuberculosis Lymphadenitis, Tuberculous Pleuritis, Tuberculous Intrahepatic Granuloma With Paradoxical Worsening and was advised to continue Category 1 Anti Tubercular Therapy.
He was prescribed prednisolone in the following doses
60 mg once daily f or 1 week
50 mg once daily for 1 week
40 mg once daily for 1 week
30 mg once daily for 1 week
20 mg once daily for 1 week
10 mg once daily for 3 days and 5 mg daily for 3 days and stop.
To follow up with a CXR after completion of 2 months of intensive phase starting from
15/3/2013. And was discharged on 17 March 2013. But the high grade fever persisted and was making the patient weak and vulnerable. Thus he came back to home town and got admitted in one more hospital. But the fever continued inspite of taking ATT and prednisolone. At this point of illness the patient came to Dr.Appa Rao’s Clinic and started his Immunotherapy. To his surprise his fever decreased in just one week and within 2-3 weeks his general health improved so much that he returned to London in one month. He continued his ATT and completed the course along with Dr. Appa Rao’s Immunotherapy.
After that he is on intermittent doses of immunotherapy and regained his health back and doing good till date. This can be supported with his recent reports showing WBC count as 7,160 cells/cmm with lymphocyte count as 39.4%. His ESR has come down dramatically to normal levels of 10mm/hr. His chest X-ray is completely normal with no evidence of any lung parenchymal abnormalities. This shows that he is completely cured of his Tuberculosis with this Immunotherapy.