Author(s):
Gauri Bhutada, Vishnu Vardhan, Bhumika Lagade
Email(s):
gauribhu1998@gmail.com
DOI:
10.52711/2349-2988.2025.00019 
Address:
Gauri Bhutada1, Vishnu Vardhan2, Bhumika Lagade3
1Second-Year MPT Student, Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha - 442001.
2Head of the Department, Cardiovascular and Respiratory Physiotherapy Department, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha – 442001.
3BPT Intern, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha - 442001.
*Corresponding Author
Published In:
Volume - 17,
Issue - 2,
Year - 2025
ABSTRACT:
The patient, a 34-year-old woman with a complex clinical presentation, is undergoing treatment for multidrug-resistant tuberculosis (MDR TB), which is resulting in damage to her breast lymph nodes and the formation of an abscess. Her anti-tuberculosis treatment (ATT) has been going on for the last eighteen months. A significant drop in platelets, white blood cells, and red blood cells indicates that the patient also has severe pancytopenia and bone marrow suppression. These hematologic anomalies aggravate her anemia, generalized weakness, and substantial weight loss. The patient has a medical history of diabetes and hypertension, which makes it more challenging to manage her overall health. In the past, she has also received blood transfusions, which is likely related to her persistent anemia and possible bleeding problems. To manage her TB, improve her haematologic condition, and treat her concomitant diseases, a multidisciplinary strategy is necessary due to the complex clinical scenario formed by the interaction between MDR TB, bone marrow suppression, and pre-existing comorbidities. The overlapping concerns of chronic infection, diabetes and hypertension control, and substantial haematologic deterioration require careful adjustments to supportive care and continuing treatment.
Case presentation:
Patient information:
The 34-year-old patient complained of weakness across her upper and lower extremities, recurrent anaemia, and substantial weight loss. She previously experienced a breast lymph node abscess and multidrug-resistant tuberculosis (MDR-TB). ATT (antitubercular therapy) has been the patient's regimen for the past 18 months. She takes medication, but not before displaying notable constitutional symptoms including generalised malaise and exhaustion. Pancytopenia and bone marrow suppression, which were discovered throughout the course of the patient's MDR-TB treatment, are also documented in her medical history. She also has a lengthy medical history of type 2 diabetes mellitus and hypertension, which are treated with antihypertensive and oral hypoglycemic drugs, respectively. The patient had severe anaemia after four days in the hospital, which was assumed to be related to bone marrow suppression. As a result, the patient needed a blood transfusion. Her anaemia persisted even after receiving the blood, though, which prompted additional investigation. A physical examination revealed substantial cachexia and the appearance of a chronic illness in the patient. She also experienced pallor in addition to a large amount of lymphadenopathy, especially in the cervical and axillary regions. A firm, unmoving lump that was sensitive to touch was discovered in the left breast during the breast exam.
Investigations in the laboratory demonstrated chronic pancytopenia, with hemoglobin levels continuously below 8 g/dL, 2,000cells/mm³ for white blood cells, and 70,000cells/mm³ for platelets. Bone marrow suppression was confirmed by a bone marrow biopsy, most likely as a result of long-term ATT use. Her blood pressure was 150/90 mmHg, and she had subpar glycemic control with a HbA1c of 9.2%.
Cite this article:
Gauri Bhutada, Vishnu Vardhan, Bhumika Lagade. Efficacy of Comprehensive Cardio-Respiratory Physiotherapy Interventions on Shortness of Breathing, 6-Minute Walk Test, Chest Expansion and Timed Up and Go Test in women with Post Mastectomy A Case Report. Research Journal of Science and Technology. 2025; 17(2):133-8. doi: 10.52711/2349-2988.2025.00019
Cite(Electronic):
Gauri Bhutada, Vishnu Vardhan, Bhumika Lagade. Efficacy of Comprehensive Cardio-Respiratory Physiotherapy Interventions on Shortness of Breathing, 6-Minute Walk Test, Chest Expansion and Timed Up and Go Test in women with Post Mastectomy A Case Report. Research Journal of Science and Technology. 2025; 17(2):133-8. doi: 10.52711/2349-2988.2025.00019 Available on: https://rjstonline.com/AbstractView.aspx?PID=2025-17-2-6
REFERENCES:
1. Lazaraviciute G, Chaturvedi S: Mastectomy—A Critical Review. Open J Clin Diagn. 2017, 7:58–66. 10.4236/ojcd.2017.72006
2. Richardson H, Ma G: The Goldilocks mastectomy. Int J Surg. 2012, 10:522. 10.1016/j.ijsu.2012.08.003
3. 3Schmauss D, Machens H-G, Harder Y: Breast Reconstruction after Mastectomy. Front Surg. 2016, 2:. 10.3389/fsurg.2015.00071
4. Cronin TD, Upton J, Mcdonough JM: Reconstruction of the breast after mastectomy. Plast Reconstr Surg. 1977, 59:1.
5. Morrow M, Jagsi R, Alderman AK, et al.: Surgeon Recommendations and Receipt of Mastectomy for Treatment of Breast Cancer. JAMA. 2009, 302:1551–6. 10.1001/jama.2009.1450
6. Al-Ghazal SK, Fallowfield L, Blamey RW: Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000, 36:1938–43. 10.1016/S0959-8049(00)00197-0
7. Kinoshita S, Kyoda S, Hirano A, et al.: Clinical comparison of four types of skin incisions for skin-sparing mastectomy and immediate breast reconstruction. Surg Today. 2014, 44:1470–5. 10.1007/s00595-013-0722-2
8. Sharma GN, Dave R, Sanadya J, Sharma P, Sharma KK: Various types and Management of Breast Cancer: an overview. J Adv Pharm Technol Res. 2010, 1:109.
9. Gieni M, Avram R, Dickson L, Farrokhyar F, Lovrics P, Faidi S, Sne N: Local breast cancer recurrence after mastectomy and immediate breast reconstruction for invasive cancer: A meta-analysis. The Breast. 2012, 21:230–6. 10.1016/j.breast.2011.12.013
10. Longman CF, Campion T, Butler B, et al.: Imaging features and diagnosis of tuberculosis of the breast. Clin Radiol. 2017, 72:217–22. 10.1016/j.crad.2016.11.023
11. Kao P-T, Tu M-Y, Tang S-H, Ma H-K: Tuberculosis of the breast with erythema nodosum: a case report. J Med Case Reports. 2010, 4:124. 10.1186/1752-1947-4-124
12. Eremin O, Walker MB, Simpson E, et al.: Immuno-modulatory effects of relaxation training and guided imagery in women with locally advanced breast cancer undergoing multimodality therapy: A randomised controlled trial. The Breast. 2009, 18:17–25. 10.1016/j.breast.2008.09.002
13. Bekele A, Gebreselassie N, Ashenafi S, et al.: Daily adjunctive therapy with vitamin D3 and phenylbutyrate supports clinical recovery from pulmonary tuberculosis: a randomized controlled trial in Ethiopia. J Intern Med. 2018, 284:292–306. 10.1111/joim.12767
14. Rodriguez M, Monedero I, Caminero JA, et al.: Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic. Int J Tuberc Lung Dis. 2013, 17:520–5. 10.5588/ijtld.12.0481
15. Field SK: Bedaquiline for the treatment of multidrug-resistant tuberculosis: great promise or disappointment? Ther Adv Chronic Dis. 2015, 6:170–84. 10.1177/2040622315582325
16. Franke MF, Appleton SC, Bayona J, et al.: Risk Factors and Mortality Associated with Default from Multidrug-Resistant Tuberculosis Treatment. Clin Infect Dis. 2008, 46:1844–51. 10.1086/588292
17. Lange C, Dheda K, Chesov D, Mandalakas AM, Udwadia Z, Horsburgh CR: Management of drug-resistant tuberculosis. The Lancet. 2019, 394:953–66. 10.1016/S0140-6736(19)31882-3
18. Szolnoky G, Lakatos B, Keskeny T, Varga E, Varga M, Dobozy A, Kemeny L: Intermittent pneumatic compression acts synergistically with manual Lymphatic drainage in complex decongestive physiotherapy for breast cancer treatment-related lymphedema. Lymphology. 2010, 42: