11/10/2025
Today’s Case at Physician Forum:
A 37-year-old female diagnosed Rheumatoid Arthritis for 5-6 years. She has been on different DMARDs with little response and is on steroids. Recently, she started on salazodine but developed a papular skin rash. She was worked up for latent TB before starting on biological. IGRA came positive, and she was started on ATT, which she took for 3 weeks.
She has chronic microcytic, hypochromic anamia unresponsive to IV iron for 5-6 years, and Hb has always been 6-7 G/dl.
She presents with high-grade fever, persistent vomiting, and abdominal pain.
Blood and urine cultures had no growth.
Extensive workup for active TB, including CXR, HRCT chest, and Sputum, were negative.
Procalcitonin and TLC were raised.
She was started on Solumedrol 500 mg IV OD, IV antibiotics, anti emetics, and PPI.
Anti DS DNA turned out to be positive.
HbsAg and Anti HCV were negative.
Autoimmune hepatitis screening negative.
Points discussed.
1. Which tests are more specific and sensitive to diagnose latent TB in low - and middle income countries like Pakistan where BCG vaccination is a routine.
2. What ATT regime and for how long to treat latent TB.
3. She is planning to start family and have a baby. What are treatment options?
4. Does she have RA, SLE, or MCTD.
Discussion was joined on Zoom by eminent Rheumatologists and Pulmonologist, oncologist, and internist, in addition to scores of PGRs.
Case was presented by Dr. Najam PGY4 and moderated by @Hunza Malik SR SMTH.
