This case study describes an 18-year-old female patient admitted to the hospital with chronic headache, vomiting, and fever. Tests revealed frontotemporal edema and meningitis. She was treated with Mannitol, corticosteroids, antibiotics (rifampicin, isoniazid, ethambutol, pyrazinamide), and supportive medications. Her condition improved and she was discharged with medications to complete a 4-month antibiotic regimen and instructions on adherence to prevent relapse or drug resistance.

1. CASE STUDY ON
TUBERCULOSIS
Presented By-
Shahnawaz Ahmad Teli
M.Pharm 2st Sem.
(Clinical Pharmacy)

2. Case presentation

3.  Patient ID: 731560/16
 Patient name: XYZ
 Age: 18 years
 Gender: Female
 Weight: 40 kg
 Date of admission: 29/09/16
 Date of discharge: 06/10/16
PATIENT DETAILS- SUBJECTIVE

4. REASON FOR ADMISSION- SUBJECTIVE (CONT..)
 Chronic Headache from 15 days
 Vomiting
 fever
•Past Medical History- Not significant
•Past Medication History - Nil
•Family history: Nil
•Social history: non-alcoholic, non-smoker

5.  General condition -- sick
 CNS -- Conscious, well oriented
 CVS -- s1 & s2 sounds heard
 Chest -- normal breathing
 P/A -- soft , non tender ,
non distended,
no organomegaly
PHYSICAL EXAMINATION:-

6. LABORATORY DATA-
Investigation 30/09/16 02/10/16 Normal Values
Creatinine (L) 0.7 0.8- 1.5 mg/dl
Hb (L) 12.1 13-17 gm/dl
RBC (L) 3.38 4.5 – 5.5 millions/cu.mm
PCV (L) 36.5 40-50 %
MCV (L) 78 83-99 fl/red cell
MCH (H) 35.8 27-33 pg/cell
ESR (H) 25 Less than 15mm/hr.
TLC (L) 4240 4000-11000 /cu.mm

7. Investigation 30/09/16 02/10/16 Normal Values
Sodium (L) 130 137-145 mmol/l
Neutrophil (N) 83 44-68 %
Lymphocyte (L) 15 25-45 %
Eosinophil (L) 0 1-6%
LABORATORY DATA-(CONTI..)

8. DAY TO DAY ASSESSMENT
Day 1-
c/o-
o chronic Headache on and
off from 15 days.
o vomiting
Medication-
Tab. Calpol (paracetamol)
650 mg SOS
Vitals-
NORMAL
Advice:
Chest x-ray

9.  Day 2-
 Pt.stable
 Montox reactive
 Vitals normal
Rx-
Inj. Mannitol 200ml over 1 hr.
Tab.Rantac (Ranitidine) 50mg
BD
Adv.- CT scan brain
o Day 3-
c/o- involuntary shaking
of right hand fingers
Vitals: Normal
Rx-
Inj. Dexamethasone 6mg iv
6 hrly.
Tab.rifampicin+isoniazid
(450+300mg OD)
Tab.Ethambutol 800mg OD
Tab.Pyrazinamide 750mg BD
Tab.shelcal OD

10.  Day 4-
C/O –same
stop Mannitol
Rest CST
o Day 5-
Advice: ivF DNS 500ml+5ml kcl 12 hrly
Rest
Rx-
Rest CST
o Day 6-
Pain in abdomen
Advice:
ivF
Stop Rantac 100mg
o Day 7-
patient better
Rest
o Day 8-
No fresh complaints
patient stable
patient discharged

11. OTHER INVESTIGATIONS
 CT scan: fronto temporal edema.
 MRI: left frontoparieral region with significat
perilesional edema and extension of edema in left
gangliocapsular region.

12. MEDICATION CHART
Name, strength, route,
frequency Date
started
Date Class
stopped
Inj.Mannitol 200ml (1hr) 30/09/16 03/10/16 Osmotic diuretic
Tab.Paracetamol 650mg
SOS
29/09/16 SOS Analgesic,antipyretic
Tab. Ranitidine 50mg BD 30/09/16 05/10/17 H2-blocker
Tab.Methylprednisolone
40mg po BD
05/10/16 06/10/17 Corticosteroid
Inj. Dexamethasone 6mg
iv 6 hrly.
02/10/16 04/10/16 Corticosteroid

13. Name, strength, route,
frequency Date
started
Date Class
stopped
Tab.Rifampicin + Isoniazid
(450+300mg) OD
02/10/16 Antibiotic,
Nicotinic acid
derivative
Tab. Ethambutol (800mg)
OD
02/10/16
antimicrobial
Tab. Pyrazinamide
(750mg) BD
02/10/16
Antibiotic,
Nicotinic acid
derivative
Tab. Ca.carbonate + vit.D3
OD
02/10/16 Nutrition
MEDICATION CHART (CONT…)

14. CLINICAL JUSTIFICATION
 Mannitol was given for edema in the temporal region.
 Corticosteroids help to reduce inflammation of the surface of
the brain and associated blood vessels, and are thought to
decrease pressure inside the brain and thus reduces the risk of
death.
 Pyridoxine should be given with Isoniazid.
 Isoniazid interferes competitively with pyridoxine metabolism by
inhibiting the formation of the active form of the vitamin, and
hence often results in peripheral neuropathy.

15. DISCHARGE SUMMARY-
 Tab.Rifampicin + Isoniazid (450+300mg) OD for 4 months
 Tab. Ethambutol (800mg) OD for 2 months
 Tab. Pyrazinamide (750mg) BD for 2 months
 Tab. Ca.carbonate + vit.D3 OD

16. PATIENT COUNSELLING
 Adherance to the drugs. Non-adherance to tuberculosis
treatment can lead to prolonged periods of infectiousness,
relapse, emergence of drug-resistance and increased
mortality and morbidity.

17. Thank You