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Pacienta, varsta 38 ani, cu sarcina in evolutie de 13 saptamani,

obtiunuta prin FIV, se interneaza in data de 6.9.2012 la Sp. V. Babesprin transfer de la Maternitatea Prof. Panait Sarbu cu dg:

Bronsita acuta ITU

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Motivele Internarii:

Sd febril

Frisoane

Cefalee

Tuse seaca persistenta

Dureri toracale stangi

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Istoricul afectiunii

Debut: Dureri toracale stangi de 4 saptamani

Sd febril 8 zile;

In perioada 3.09-5.09 a fost internata laMaternitatea Prof. Panait Sarbu pt contractiiuterine dureroase, metroragii, febra.

La exam urinar: piurie, urocultura negativa.

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Istoricul afectiunii

Consult: pneumologic: Bronsita acuta

Tratament: Augmentin, 2 g/zi, 6 zile

Evolutie: nefavorabila, fara disparitia febrei, fara

ameliorarea tusei. Internare: Sp. V. Babes

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APP

Trombofilie

Sarcina extrauterina operata in 2010

Complex primar calcificat pulmonar 2011

1 aug pierde continutul unui sac embrionar apoimetroragii

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Clinic La internare:

Febrila 38,3C

Stare generala mediocra Constienta pastrata

Buze uscate,tegumente palide

Faringe discret hiperemic

Tuse seaca pesistenta MV diminuat in baza stg fara raluri

Giordano + stg

Urini hipercrome

Fara manif neurologice de focar, fara redoare de ceafa

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Clinic

Evolutie:

La data de 8.09 pacienta acuza:

Cefalee occipitala,

Fotofobie,

Ptoza palpebrala stg

Consult neurologic: constienta, cooperanta,dedublarea imaginii in privirea la stg, fara modifoculomotorii

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Laborator

Punctia lombara: LCR clar Nr elem nucleate 19/mmc R. Pandy ++++ Albuminorahie 1,98 g/L Glicorahie 0,35 g/L Frotiu Ziehl Neelson neg RT-PCR din LCRM T +99 copii/L Frotiu Ziehl Neelsen + la 19 zile

Culturi + din LCR pe mediul Lowenstein pt MT.

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Laborator

VSH- 34 mm/h

Hb-7,7 g/dl

Ht-22,9%

Glicemie-74 mg/dl

Neutrofile 83%

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Laborator

Sediment urinar:

Epitelii relativ frecvente

Leucocite 7-8/camp

Eritrocte 5-6/camp

Uroculturi- E. Coli multirezistent, sensibil la

Imipenem

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IRM cerebral fara modificari Eco abd- rinichi drept ptozat 5 cm, microlitiaza

calice inferior

Uter gravid, Batai cardiace fetale ritmice, mic

hematom pol inferior sac ovular

Eco toracica- lichid pleural bilateral in cantitatemica

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Diagnosticul pozitiv

Meningita subacuta TBC, pleurezie TBC

Pielonefrita E. Coli MDR

Enterocolita Cl. Difficile post antibioterapie

Anemie hipocrom-microcitara

Sarcina 13 sapt in obs

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Tratament

Din 10.09 tratm tuberculostatic,regim 7/7

Isoniazida 300 mg/zi

Rifampicina 600 mg/zi

Pirazinamida 2000 mg/zi

Etambutol 1600 mg/zi

Corticoterapie( initial Hemisuccinat HC 100mg iv la6 h, 3 sapt, apoi cu scadere la fiecare sapt)

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Imipenem 10 zile pt PNF cu E. Coli MDR

Dupa 4 zile prezinta scaune diareice, febra 39C,coprocultura Test RIDA QUICK + Cl Difficile toxina

A/B : se instituie tratam cu Flagyl 250 mg la 6h, 7

zile cu evolutie favorabila. Vitaminoterapie

Hepatoprotectoare

2 transfuzii masa eritrocitara

Tratam tocolitic

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Curba Termic

38.4

37.5

38

38.3

37.8

38.8

38 38 38

37.4

36.8 36.8 36.8 36.8

38.3

37.3

37

37.8

37.2

37.4

39

37.7

36.8 36.8 36.8 36.8

37.8

36.8

35.5

36.0

36.5

37.0

37.5

38.0

38.5

39.0

39.5

40.0

40.5

6-

Sep

7-

Sep

8-

Sep

9-

Sep

10-

Sep

11-

Sep

12-

Sep

13-

Sep

14-

Sep

15-

Sep

16-

Sep

17-

Sep

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Sep

19-

Sep

20-

Sep

21-

Sep

22-

Sep

23-

Sep

24-

Sep

25-

Sep

26-

Sep

27-

Sep

28-

Sep

29-

Sep

30-

Sep

1-

Oct

2-

Oct

3-

Oct

Data

temperatura(C)

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Recomandari

Va continua tratament cu 4 tuberculostatice 7/72 luni, ulterior 2 tuberc 7/7 pana la 10 luni,

medrol 16 mg, Omez 1 cp/zi, Liv 52 2cp/zi,Supradyn 2 cp/zi, Ferogradumet 2 cp/zi.

Control obstetrical periodic.

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Particularitatea cazului

Aparitia meningitei TBC la o femeie gravida, peun teren imunodeprimat

Individualizarea trat antibiotic

Dificultatea diagnosticarii( interzisa efec Rxtoracice)

Suprainfectie cu Cl. Difficile