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HIV positive patient. CT scan showed non-necrotic mediastinal lymphadenopathy. What are the chances of TB?

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Practicing since : 2003
Answered : 588 Questions
Hello Doctor,
     I’m a HIV positive patient with CD4 count 67 /μl and viral load 0000 copies/ml. i had occasional pain in the right side of my abdomen ( 3 times in last 6 months). I suffered herpes zoster a year ago.
I went to doctor to get ART . he wanted me to get a CT scan of chest done.

The CT scan showed that I have non-necrotic mediastinal lymphadenopathy ( report attached.)
I absolutely do not have cough , do not get fever , my weight is stable from last 3 years, no night chills, and I have healthy apatite.

My questions are
1)     Is there a possibility of TB ? what are the chances? How to test it further.
2)     If I have TB , can I take ART and medicine for TB together.?

I’ve appointment with doctor tomorrow. However your opinion will be really helpful to me.

Thanks in advance.
Posted Tue, 24 Jul 2012 in Lung and Chest disorders
Answered by Dr. Gyanshankar Mishra 14 hours later
Thanks for posting the query on XXXXXXX
After going through your query, I would like to comment the following:

1. Considering your HIV status and a low CD4 count, the presence of mediastinal lymphadenopathy points towards a very probable cause of tuberculosis as the etiological cause of mediastinal adenopathy.

2. Supportive investigations are: Ultrasonography of the abdomen, Mantoux test, Clinical examination for other sites of lymphadenopathy (If found any then FNAC from the lesion).

3. Considering your low cd4 count art and tb medications can be started simultaneously.

4.Also you need PCP and MAC prophylaxis (With septran and axithromycin respectively) at your CD4 count. Please discuss this issue with your doctor.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.


Dr. Gyanshankar Mishra
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