Systemic bcg with pneumonitis
Download
1 / 8

- PowerPoint PPT Presentation


  • 154 Views
  • Updated On :

Systemic BCG with Pneumonitis. By Carrie Fitzgerald Uro 1. Urology consult for patient with irritative symptoms R/O UTI 81 year old African American male, appears younger then stated age

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about '' - misha


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Systemic bcg with pneumonitis l.jpg

Systemic BCG with Pneumonitis

By Carrie Fitzgerald

Uro 1


Hospital day 3 l.jpg

Urology consult for patient with irritative symptoms R/O UTI

81 year old African American male, appears younger then stated age

  • Presents with c/o irritative voiding sxs for 24 hr. daughter noticed diaphoresis acute change MS; dysuria, fever 103 brought pt to ER.

  • Pt seen by medicine and started on empiric parenteral antibiotic treatment after urine culture obtained

  • Found out 72 hours later patient was post BCG intravesical treatment, including dysuria and frequency and urology consult obtained

PMHx

Superficial Bladder Ca sp BCG 6 week induction; maintenance dose 72 hr prior; ho sxs post intraves

CaP s/p RRP

Dementia

HTN

Meds : Aricept, Cozaar , Enablex, HCTZ, Norvasc, Colace

Soc Hx: Tob 30 pack yr, no ETOH, no illicits

FamHx: no GU malignancies

Hospital day 3


Labs and exam l.jpg

  • VS 100.2 82 22 154/86 96%

  • AAOx2, NAD

  • CTAB, S1S2 no murmurs

  • Soft, NT no sp ttp, no CVA tenderness

  • Uncircumsize. Nl Descended. Foley gravity, urine clear, yellow, no meatal erosion bld. Prostate absent.

  • WBC 5.4 (13.5/ band % 13 on admit)

  • H/H 11.4/32

    12.9/36.4 on admit

  • BUN 13 Cr 1.16 (35/2.47 on admission)

  • AST 93 ALT 94AlkP92

  • T bili2.26 D bili1.18

  • Sterile pyruria (W 20-50)

  • CXR

Labs and Exam


Assessment and plan l.jpg

Assessment:

UTI vs BCG side effect vs systemic BCG

Hyperpyrexia

AKI

Hyperbilirubinemia

Anemia

HTN

  • Bld/U Tb cx

  • ID consult

  • Levaquin, INH

  • WBC Scan

  • Abd US

  • CT scan abd/pel

  • Renal cyst /abscess drainage

Assessment and Plan


Results and pe l.jpg

Episodes of fever (Tmax 104.4) and diaphoresis Q8-12 hour

Expiratory wheezes; O2 sat80%

Rigors

Change in MS

Results and PE


Hospital day 13 l.jpg

Assessment

Disseminated BCG

+/- hypersensitivity rxtn

Respiratory distress

Hepatitis BCG vsPharm

Hyperpyrexia

Anemia – AOCD w/folate def

Urinary incontinence

AKI

HTN

WBC 9.6

(11/band% 25 hosp day 17)

H/H 8.3/24

(7.5/21.9 hosp 17)

BUN 21 Cr 1.38

AST 162 ALT 78

AlkP102

T bili3.01 D bili1.93

PSA < 0.01

HepBab/Ag - neg

Hospital Day 13


Treatment l.jpg

  • Rifampin 600 mg po Qd

  • Pyrazinamide 1000 mg po Qd

  • Isoniazid 300 mg po Qd

  • Levaquin 250 mg po Qd

  • Stopped Pyrazinamide on 10/27 started Ethambutol 1600mg po daily

  • Zosyn 3.375 g x1

  • Vancomycin 750 mg x 1

  • Rocephin 1g x1

  • Azithromycin 500 mg x1

Treatment


In addition l.jpg

  • Lamm consult

  • Started Solumedrol 40 mg IVP Q 6 hours hosp day 17 with slow taper

  • Discharged to rehab hosp day 20

In Addition


ad