1Second-Year MPT Student,
2Head of the Department
3BPT Intern,
*Corresponding Author E-mail: gauribhu1998@gmail.com
The patient, a 34-year-old woman with a complex clinical presentation, is undergoing treatment for multidrug-resistant tuberculosis (MDR TB), which is resulting in damage to her breast lymph nodes and the formation of an abscess. Her anti-tuberculosis treatment (ATT) has been going on for the last eighteen months. A significant drop in platelets, white blood cells, and red blood cells indicates that the patient also has severe pancytopenia and bone marrow suppression. These hematologic anomalies aggravate her anemia, generalized weakness, and substantial weight loss. The patient has a medical history of diabetes and hypertension, which makes it more challenging to manage her overall health. In the past, she has also received blood transfusions, which is likely related to her persistent anemia and possible bleeding problems. To manage her TB, improve her haematologic condition, and treat her concomitant diseases, a multidisciplinary strategy is necessary due to the complex clinical scenario formed by the interaction between MDR TB, bone marrow suppression, and pre-existing comorbidities. The overlapping concerns of chronic infection, diabetes and hypertension control, and substantial haematologic deterioration require careful adjustments to supportive care and continuing treatment.
The 34-year-old patient complained of weakness across her upper and lower extremities, recurrent anaemia, and substantial weight loss. She previously experienced a breast lymph node abscess and multidrug-resistant tuberculosis (MDR-TB). ATT (antitubercular therapy) has been the patient's regimen for the past 18 months. She takes medication, but not before displaying notable constitutional symptoms including generalised malaise and exhaustion. Pancytopenia and bone marrow suppression, which were discovered throughout the course of the patient's MDR-TB treatment, are also documented in her medical history. She also has a lengthy medical history of type 2 diabetes mellitus and hypertension, which are treated with antihypertensive and oral hypoglycemic drugs, respectively. The patient had severe anaemia after four days in the hospital, which was assumed to be related to bone marrow suppression. As a result, the patient needed a blood transfusion. Her anaemia persisted even after receiving the blood, though, which prompted additional investigation. A physical examination revealed substantial cachexia and the appearance of a chronic illness in the patient. She also experienced pallor in addition to a large amount of lymphadenopathy, especially in the cervical and axillary regions. A firm, unmoving lump that was sensitive to touch was discovered in the left breast during the breast exam.
Investigations in the laboratory demonstrated chronic pancytopenia, with hemoglobin levels continuously below 8 g/dL, 2,000cells/mm3 for white blood cells, and 70,000cells/mm3 for platelets. Bone marrow suppression was confirmed by a bone marrow biopsy, most likely as a result of long-term ATT use. Her blood pressure was 150/90 mmHg, and she had subpar glycemic control with a HbA1c of 9.2%.
Cardio-Respiratory, Physiotherapy Interventions
