I have often seen patients that have medical problems and the treatment is started and patients and the physicians look for the completion of therapy. Certainly this is not true for high blood pressure or diabetes, in many cases the treatment is life long . But say someone has lung cancer and we decide to have surgery and so when the surgery is done and that is successful, the so called treatment is over-complete. Pneumonia would be other condition . Do antibiotics and the treatment is done with. But in some patients we end up having one thing leading to other. This is such a story.
I saw this patient in my office who was seen by other lung specialist in past. She had abnormal CT scan of chest and the physician had done bronchscopy and she had MAC -the atypical TB called mycobacterial intracellular and so she was started on medications but somehow he did not do much follow up and so she came to me. She came to me . We did the follow up on CT scan and also did new sputum for TB bacteria and then continued to do the follow up. She was doing OK and at the end of almost 1 year of treatment we did new CT scan . The treatment for this disease is usually for 18 months , Or 6 months after the sputum is negative. This is done as the chance of recurrence is high if treated for shorter duration. The CT scan showed some worsening of the findings and so I did do new bronchoscopy and that showed that she still had MAC. So I added 4th medicine . So now she was on 4 drugs and we had already exceeded 18 months . But then i did do new sputum check in 3 months and that was negative . The scan was OK and she had no complaints. So we were happy and we had plan to stop the medication in short time. But we did new sputum check and IT SHOWED A DIFFERENT MYCOBACTERIUM.
So now we are stuck with treating her with NEW DRUG and for HOW LONG ?
But I know there is a light at the end of tunnel.
