Diagnosis #1: Necrotizing granulomas, cervical lymph node, acid-fast organisms present. Non-necrotizing granulomas, pleura, no acid-fast organisms seen.

Course continued: On discharge, the patient was being treated with INH, rifampin, ethambutol, and pyrazinamide on daily directly observed therapy. He also received prednisone, 60 mg/day, for tuberculous pleurisy and pericarditis. His sputum, pleural fluid, and tissue cultures revealed pan-sensitive M. tuberculosis, and the ethambutol was stopped. His HIV serology was positive, and his CD4 count was 199/µl. Oral thrush was noted. As an outpatient, his corticosteroid dose was tapered to 30 mg per day. Two months following discharge, he presented to the Tuberculosis Clinic with sharp, right-sided, pleuritic chest pain. He had noted the pain approximately one week earlier, but it had progressed over the last 24-48 hours. Chest examination showed markedly decreased breath sounds on the right, and a chest X-ray and CT scan were obtained.

Clinical summaryCT scan

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