Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic productive cough, exertional dyspnea, and fatigue. History of voluntary cough suppression, low BMI, and pectus excavatum noted. Symptoms are indolent, characterized by intermittent hemoptysis and occasional pleuritic chest pain. No systemic B-symptoms reported.
Clinical Examination Findings
General: Thin-framed, elderly female in no acute distress. Chest: Auscultation reveals bilateral crackles, predominantly in the right middle lobe and lingula. Percussion: Dullness noted in lower lung fields. Vitals: Stable, afebrile. Skin: No evidence of lymphadenopathy or cutaneous nodules.
Treatment Protocol
Management plan: Initiate multi-drug regimen (Clarithromycin/Azithromycin, Rifampin/Rifabutin, and Ethambutol). Airway clearance therapy (ACT) prescribed twice daily. Monitor LFTs, CBC, and renal function. Baseline and serial visual acuity/color vision testing required due to Ethambutol. Consider inhaled amikacin for refractory cases.