2. Patient History
DD: Mahad Hasan 32 years old man from Djabouti
CC: Progressive Shortness of breath for 2 weeks.
HPI: the patient was healthy young man until three years
ago when he first develop a progressive shortness of
breath that was gradual onset aggravated and relieved by
nothing associated with cough that is productive and also
lower extremity edema, no fever, no chest pain and no
palpitations and no other complain.
3. • PMH: he has chronically recurrent pleural effusions and extremity
edema, he was in a TB facility in Djabouti and received TB
treatment two times, the last of which was 8 months ago although
he was never had a sputum test in Jabouti as he claims he received
TB diagnosis based on chest X-ray done at the time, and after 6
months he completed his TB treatment course which was his
second round after he was non-complaint in his first time. no
diabetes, no hypertension and no other chronic illness
• PSH: he had multiple thoracocentesis with needle and some times
with chest tubes, but no surgery or transfusion.
4. • Drug H: he is not on any medication currently and he
completed TB treatment course 8 months ago.
• Family H: no similar condition in the family and no
family history of liver, heart and kidney disease.
• Social H: he does smoke and chew khat but he doesn`t
do any other substance use…. He works as a driver for
a transportation company.
5. Physical examination
• Vital signs: BP: 110/70 P: 93 T: 36.8Cel RR:28 O2: 87% (RA).
• Cardiac: unremarkable
• Respiratory: dullness to percussion of both lungs with
reduced air entry bilaterally as well as diffuse crackles.
• Abdomen: unremarkable except for tender hepato-magely.
• Extremities: bilateral pitting edema of both legs up to the
knees.
• Skin: normal.
6. Assessment and plan
• RD 2nd ry to pleural effusions 2ndry to recurrent TB/
decompensated heart failure/ liver failure/ kidney
failure / hypothyroidism.
• CBC, CR, UA, CXR, CT of the chest and echo, AFB, TSH
and pleural fluid analysis, serum albumin.
• RUQ tenderness and hepatomagely 2nd ry to viral
hepatitis /TB meds.
• Abdominal Ultrasound, LFTs, and stool exam.
7. Investigations:
• CBC: WBC: 10k HgB: 15 g PLT: 229K MCV: 87
• LFTs: ALT:19 AST:22 ALKPHS: 198 Tbilli: 1.1 D billi: 0.4
• Cr:0.7
• Serum Albumin: 33.28 (38-51)
• TSH: 3.0 (0.3-5.6)
• UA: normal
• ECHO: normal systolic function and mild pericardial effusion
• Abdominal Ultrasound: hepato-spleenmagely, portal HTN, congested liver and dilated
hepatic vein.
• CXR: bilateral massive pleural effusions para-hilar reticulo-nodular opacity
• CT of the chest: bilateral massive pleural effusions.
• Acid fast bacillus: negative.
• Stool exam: normal
• Electrolytes: normal
