Persistent Cough, Night Sweats and Haemoptysis

🗒️ Question

A 45 year old man presents to the GP with a 3 month history of persistent cough, night sweats, weight loss and occasional haemoptysis. He reports feeling fatigued and has recently returned from visiting family in India. He has no significant medical history and is not on any regular medications.

On examination, he has a temperature of 37.9°C, respiratory rate 20 breaths per minute, heart rate 98 bpm and oxygen saturation is 95% on room air. Auscultation reveals coarse crackles over the right upper lung field.

Investigations

Chest X-ray: Right upper lobe cavitation

Sputum smear: Positive for acid-fast bacilli

What is the most appropriate initial management?

(A) Start a 6 month course of isoniazid and rifampicin

(B) Start a 2 week course of ciprofloxacin

(C) Initiate a 4 drug regimen of rifampicin, isoniazid, pyrazinamide and ethambutol

(D) Refer for surgical resection of affected lung

(E) Supportive care and regular monitoring