Internal medicine clerkship case presentation on
RVI, Pulmpnary TB and Pyrogenic meningitis
By : Shikur Yasin HSR/0031/11
Submitted to: Mr. Teshale (assist. Professor )
Name : M.K
age: 59 years old
card No: 224794
bed No: 806/3
Date of admission:
Presented with fever and
headache for 3 days.
Presented with 3day history of
globalized throbbing type headache ,
fever, and neck stiffness.
Known RVI patient for the past 2 month and a week and she
is on HAART(1J) but unknown CD4 count and viral lode
She had also diagnosed with pulmonary TB before 2 month
ago and on anti TB(RHZE).
there was no family member with TB
She is a merchant and lives with
She has no history of smoking and
OTC: paracetamol 1g PRN
CAM (complementary alternative medicine): no known CAM
Allergies and ADRs: she had no known allergy and no ADR
has been reported until this time.
GA: well looking
HEENT: pc, NIS
Neck and lymph node: Nucheal rigidity, no palpable LAP
CVS: s1and s2 weal heard , no gallop and murmur sound.
R/S :Bilateral few creptation on the back 1/3 rd of posterior chest.
ABD: flat, moves with respiration, No signs of palpable
GUS: no CVAT
MSS: Grade one bilateral pitting edema.
Current drug therapy during hospitalization
For RVI: (started before 2 month
and a week)
1J 1 tab po/day
For P.TB (started before 2 month )
RHZE 4 tabs po/day
Pyridoxine 25 mg po /day
For Pyrogenic meningities: (16 th day)
Vancomycin 1g 1V BID (discontinued in 15th day)
ceftriaxone 2g IV BID (discontinued in 15th day)
Ampiciline 2g IV QID
For depresion : (3rd day) Floxetine 20 mg /day
For pain and headache: (16 th day) Tramadol 50
mg IV PRN and PCM 1gm po PRN respectively
The patient have good progression in symptoms.
The fever were relieved.
Neck stiffness and signs of infection were subsiding.
Indication DTP Comment Plan
Indication Hypokalemia Needs additional
Since the patient
Since she is
stage Iv RVI
patient she needs
Drug related need Indication DTP Comment Plan
Effectiveness INH induced
Dose too low The dose of
pyridoxine in this
scenario is 50mg
Make the dose of
pyridoxine 50 mg
Effectiveness RVI Dose too low Since Rifampcin is
Make the dose of
DTG 100 mg po
/day or 50 mg po
Desired therapeutic outcome
Eradication of infection (meningities and PTB)
Making viral lode undetectable < 50 copies/ml
maintain normal serum electrolyte.
Initiate KCL 40 ME IV TID
Iniciate Cotrimoxazole double strength (960 mg) 1 tab po/day
Make the dose of pyridoxine to 50 mg po/day
Make the dose of DTG 50 mg BID
Parameters to evaluate the outcome
Improvement in symptoms
CBC especially WBC differentials.
CD4 count and viral lode status
Communication and implementation of the
The plan has communicated and some of them has been
implemented and some are on progress.
KCL 4o ME iv TID (accepted and implemented)
DTG 100 mg po/day (acepted and implemented)
Cotrimoxazole 960 mg po/day (on progress)
Pyridoxine 50 mg po/day (on progress)
1. STG 2020:
2. Guidelines for clinical and programmatic management of TB ,
TB/HIV, DR-TP and leprosy in Ethiopia 2021
3. American clinical practice guidelines for treatment of drug susceptible