Suggest treatment for  granulomatous lesions seen in CXR
Patient: Hi, 2 months ago my husband was having persistent cough and coughed out blood once. I am not sure if it was blood streaked sputum or all blood because he did not tell me right there and then, so I did not see the color and everything. So we went to see a doctor and she ordered chest xray, CBC. The xray was abnormal so she ordered sputum AFB and culture which turned out negative and CBC was also normal. And as hard headed as my husband is he did not go back for follow up. A week ago he said he cough and went to a Pulmonologist and did another CXR which showed granulomatous lessions suggesting Koch's. The CXR from 2 months ago hasn't changed. Do we have to do another sputum culture? By the way, he is a smoker of 10 sticks a day since he was a teenager. Doctor: Hi, welcome to Healthcaremagic. Koch's or tuberculosis is a disease which may affect any of the organ of body but most commonly, it affects lungs. The patient may present with productive cough with sputum and low grade fever in evening and lethargy with weight loss. Sometimes, sputum culture is negative because tuberculosis bacteria is fastidious organsism and requires time for positivity on culture media. I would suggest that please start the antituberculosis drugs and do a gene xpert TB PCR test for confirmation.Ask him to quit or reduce smoking.