HISTORY OF PRESENT ILLNESS

Patient Identification: R. L.
Date of Admit: 6/18/97
Age: 40
Sex: Male

I. Chief Complaint: Increasing shortness of breath, cough, fevers and weight loss.

II. History of Present Illness: The patient is a 40 year old homeless Hispanic male with history of tuberculosis first diagnosed in January 1993 admitted to the hospital from TB control for treatment of multiple drug resistant (MDR) tuberculosis. On presentation, patient complained of productive cough, increasing shortness of breath, as well as weight loss and night sweats. The patient's history of TB dates back to January 1993 when he was first diagnosed with isoniazid (INH) resistant pulmonary TB. At the time, he was treated with rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) but subsequently was lost to follow-up . In December 1994, he was found to have INH, RIF, and PZA resistant TB in Mexico. Cultures at the time showed sensitivity to capreomycin, ethambutol, ethionamide, and ofloxacin and patient was treated with PZA, ciprofloxacin, EMB, and kanamycin for five months but subsequently lost to follow-up again. In November 1995, patient did have another AFB positive smear in Mexico but left hospital without treatment.