They found lesions in the cells that are consistent with TB infection. What keeps her tummy bloated is chronic inflammation caused by infection.
They will have the specimens taken for further tests like GeneXpert MTB/RIF assay to know the drug resistance and susceptibility. So in the course of treatment some things may change.
MTB infections in the Philippines are really the nasty ones, especially the extra-pulmonary, since it’s a great mimic that makes it hard to diagnose. In our case, it tried its very best to mimic lymphoma, down to the rapid accumulation of uric acid.
No wonder in the provinces, which have limited or no access to modern instruments and newer reagents, ex-PTB detection is extremely hard. The disease keeps swirling around within communities and keeps on developing drug resistance. This is a public health concern that needs government support such that people from all walks of life can afford to buy anti-TB meds good for 12 months. Otherwise, MTB will keep on developing strong resistance to drugs just because a family couldn’t afford to buy anti-TB meds anymore. One month of skipped medication could mean the disease can come back with a vengeance. Sadly, this is a common theme all over the Philippines.
What makes it more difficult for my daughter is that MTB didn’t present itself in the fecalysis because it turns out the infection is outside the intestines and colon. I remember our hema-onco saying that she wanted some tissues taken from the colon because she saw a slight thickening of the walls. Again, thickening of the colon walls could indicate infection or malignancy. Up to the last moment, it’s still a toss-up between GI TB and intestinal lymphoma.
Even though my daughter is already being treated for TB, we’re still not cleared for malignancy since it’s the histopathology that would determine that. And it would take three weeks.
I personally feel that up to the last moment, we were battling cancer. We were like a hairline between TB and lymphoma.
Prayers made a lot of difference. Thank you, Lord.
Ice cream for some serotonin boost.
We are going home tomorrow!!!
I finally spoke to our IDS, not just the fellows, and she said that once she saw the granulomas, she immediately issued the order to reinstate the anti-TB meds and order a discharge within 24 hrs. Granulomas are unmistakable characteristic of TB. She just had sent the ascite fluid to RITM to ID the MTB and test for resistance. But even without the GeneXpert test and PCR, she is already confident that all the symptoms presented are that of TB.
During the biopsy when they drained my daughter’s ascites (about 90ml of it), she asked for a photo of the collected specimen. The color already told her it was TB.
She said they decided to do this intervention biopsy vs more tests to check for lymphoma and other cancers to save me the agony of being perpetually on the edge.
Thank you, doc, for saving my sanity.