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What Causes Chronic Persistent Cough?
Question: Hello Sir! My wife was suffering from cough from last 1 month. During this i gave her cefixime + azithromycine and suddenly 1 day a lymphnode occured on her neck. First doctor declared that she has TB and prescribed Forecox, with Reheptin(metadoxine, silymarin, L- ornithine L-Aspartate, pyrodoxine hydrochlorine & folic acid) Benadon(pyrodoxinr hydrochloride), Zedocef(cefpodoxime proxetil and potassium clavulanate) and another doctor says she dont have TB. Both the doctor are chest and TB specialist.
Important notes-:
-Lymphnode consist with pus.
-After 2 days of medication of 1st doctor, lymphnode reduced from 4 inches long to a size of 1 inch n neither decreased nor increased from 1 inch still after 10 days.
-After 4 days of medication of 1st doctor we stopped forecox and reheptin. As per 2nd doctor we continued with zedocef and start amoxycilin and a cough syrup.
Inspite of continution of antibiotic her coughing have not cured yet and its been 1.5 month she is suffering with cough.
Diagnosis report-:
-ESR - 18
-Sputum Culture - Negative
-Z-N Stain of pus - AFB not seen in smear examined.
- 1st report of AFB Culture of pus - AFB not seen in smear examined.
- 2nd report of AFB culture - No mycobacterium species grown on culture after 10 days of incubation.
Cystology/ FNAC:-
Clinical details: ? Tubercular
- 3 prepared cystomears received
- Stains used - H & E
Microscopic findings:-
Cystomears shows completely acellular necrosed material. Nature of necrosis is of caseous type.
* Pissibility of tubercular lesion is suggested. Kindly correlate clinicaly.
I have written all the necessary details with patient history. Kindly suggest me.
Important notes-:
-Lymphnode consist with pus.
-After 2 days of medication of 1st doctor, lymphnode reduced from 4 inches long to a size of 1 inch n neither decreased nor increased from 1 inch still after 10 days.
-After 4 days of medication of 1st doctor we stopped forecox and reheptin. As per 2nd doctor we continued with zedocef and start amoxycilin and a cough syrup.
Inspite of continution of antibiotic her coughing have not cured yet and its been 1.5 month she is suffering with cough.
Diagnosis report-:
-ESR - 18
-Sputum Culture - Negative
-Z-N Stain of pus - AFB not seen in smear examined.
- 1st report of AFB Culture of pus - AFB not seen in smear examined.
- 2nd report of AFB culture - No mycobacterium species grown on culture after 10 days of incubation.
Cystology/ FNAC:-
Clinical details: ? Tubercular
- 3 prepared cystomears received
- Stains used - H & E
Microscopic findings:-
Cystomears shows completely acellular necrosed material. Nature of necrosis is of caseous type.
* Pissibility of tubercular lesion is suggested. Kindly correlate clinicaly.
I have written all the necessary details with patient history. Kindly suggest me.
Brief Answer:
Most likely she has tubercular lymphadenitis.
Detailed Answer:
Hello XXXXXXX
Your wife has cough for 1 month. Her FNAC lymph node is suggestive of tubercular etiology.
The reduction in the size of lymph node could have been because of antibiotics or because of forecox. You should not have stopped ATT(forecox). However, now that you have stopped, I suggest either you go in for a second FNAC or better, an excision biopsy of the lymph node which can be then subjected to HPE.
Is she running fever, esp low grade with evening rise. Is she still having cough? Is there any weight loss?
What about her x ray chest and Montoux test? Pl get these also done and then consult your chest physician for advise on ATT.
Most likely she has tubercular lymphadenitis.
Detailed Answer:
Hello XXXXXXX
Your wife has cough for 1 month. Her FNAC lymph node is suggestive of tubercular etiology.
The reduction in the size of lymph node could have been because of antibiotics or because of forecox. You should not have stopped ATT(forecox). However, now that you have stopped, I suggest either you go in for a second FNAC or better, an excision biopsy of the lymph node which can be then subjected to HPE.
Is she running fever, esp low grade with evening rise. Is she still having cough? Is there any weight loss?
What about her x ray chest and Montoux test? Pl get these also done and then consult your chest physician for advise on ATT.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Mam!! Second doctor says her x-ray is clean. Yes she had low grade fever near about 1 month. Then we went for some checkups and she got vidal positive. Then we gave oframax injection. After that she dont have complaint of low grade fever. So now, what would you suggest. We should go for biopsy or 2nd FNAC or again start forecox. Second doctor says her x-ray is clean.I would like to add 1 more thing. Yes weight loss is there but after forecox bcoz she had vomiting due to forecox.
Brief Answer:
Go in for lymph node biopsy.
Detailed Answer:
As I said since you have already stopped forecox, you go in for lymph node biopsy or FNAC and consult a chest physician with the reports. In my opinion, it looks like tubercular.
Go in for lymph node biopsy.
Detailed Answer:
As I said since you have already stopped forecox, you go in for lymph node biopsy or FNAC and consult a chest physician with the reports. In my opinion, it looks like tubercular.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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