SHM Converge Scientific Abstract ePoster Gallery-Making the Diagnosis the New Fashioned Way

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A 15-year-old male with HIV and poor antiretroviral adherence presented in Lilongwe, Malawi with weight loss, night sweats, chronic lower-extremity rash, and diarrhea. He appeared cachectic but had normal vital signs, no palpable lymphadenopathy, and an otherwise unrevealing physical exam. The rash was erythematous, flat, and slightly raised centrally, starting on the legs and spreading to the arms over 4 months.<br /><br />Point-of-care ultrasound using the FASH protocol revealed several findings concerning for extrapulmonary tuberculosis: abdominal para-aortic lymphadenopathy, hyperechoic splenic lesions with posterior shadowing consistent with calcifications, and no pericardial or pleural effusions, ascites, or focal liver lesions. Additional testing showed a positive urine lipoarabinomannan (LAM) test and a high HIV viral load of 271,000, further supporting disseminated TB.<br /><br />Based on the combination of clinical presentation, POCUS findings, and laboratory data, the patient was diagnosed with disseminated tuberculosis. He was started on standard TB therapy with rifampin, isoniazid, pyrazinamide, and ethambutol, and antiretroviral treatment was restarted. On follow-up several months later, his symptoms and rash had resolved.<br /><br />This case highlights the value of the FASH exam, a POCUS protocol developed to detect signs of extrapulmonary TB in patients with HIV in high-burden, resource-limited settings. Ultrasound findings such as abdominal lymphadenopathy and splenic lesions can help identify TB earlier and expedite treatment.

Asset Subtitle

Erin M. Finn

Meta Tag

Author List Benjamin Lin, Emily Ciccone, Erin M. Finn, Ria Dancel

Category Clinical Vignettes

Concept FASH Exam

Concept Disseminated Tuberculosis

Concept Extrapulmonary Tuberculosis

Concept Standard TB Therapy

Concept Point-of-Care Ultrasound

Distinguished Finalist

Presenter Organization University of North Carolina

Presenting Author Erin M. Finn

Track Pediatric

Keywords

HIV

disseminated tuberculosis

FASH protocol

point-of-care ultrasound

extrapulmonary TB

abdominal lymphadenopathy

splenic calcifications

urine lipoarabinomannan

antiretroviral adherence

resource-limited settings

FASH Exam

Disseminated Tuberculosis

Extrapulmonary Tuberculosis

Standard TB Therapy

Point-of-Care Ultrasound