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Difficult to Diagnose Case of Pulmonary Tuberculosis in a Patient With COPD FREE TO VIEW

Bianca Paraschiv, MD; Claudia Lucia Toma, PhD; Stefan Dumitrache-Rujinski, PhD; Liliana Grigoriu, MD; Ionela Nicoleta Belaconi, MD; Codin Saon, MD; Miron Alexandru Bogdan, PhD
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National Institute of Pneumology "Marius Nasta", Bucharest, Romania

Chest. 2014;145(3_MeetingAbstracts):89A. doi:10.1378/chest.1832778
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SESSION TITLE: Tuberculosis Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Pulmonary tuberculosis is an ancient contagious disease which remains a public health issue due to a large reservoir of latent infection (1).

CASE PRESENTATION: We present a case of unique clinical presentation of tuberculosis in a patient with COPD. A 70 years old engineer, ex-smoker (55PA), with a history of tuberculosis (1967), systemic hypertension (since 2002), COPD (since 2006), who was admitted in 2009 for high fever, dyspnea, cough and muco-purulent sputum production. Physical examination revealed an underweight (BMI= 16,4 kg/m2) and febrile patient (38.2C), with cough, purulent sputum, pale skin, diaphoresis, dyspnea with orthopnea position, normal breath sounds bilateral with no pulmonary rales. The lab tests showed a mild leukocytosis with inflammatory syndrome (WBC 13.000/μL, ESR 74mm/h). Chest X-ray revealed a patchy condensation in the right upper lobe. Given the results of the investigations, community acquired pneumonia was suspected and antibiotic treatment was started while waiting for the culture results. Repeated cultures from sputum and bronchoalveolar lavage were negative for bacteries, including M. tuberculosis. The patient’s clinical status worsened and the leukocytosis and inflammatory syndrome worsen (WBC -24.400/ μL, ESR-112mm/h, Fibrinogen - 896mg/dL, CRP- 171mg/L). The HRCT-scan revealed the persistence of the patchy condensation in the right upper lobe-figure 1. Bronchiolitis obliterans organizing pneumonia was suspected and corticotherapy was added. Patient’s clinical status worsened again, with the persistence of negative repeated cultures for non-specific bacteria and an exploratory thoracotomy with biopsy was performed. The pathological examination from the right upper and medium lobes showed extensive parenchymatous lesions with necrosis and granulomatous inflammatory infiltrates and fibous-exudative alveolitis, suggestive for pulmonary tuberculosis. The cultures for M. Tuberculosis came positive after 2 months. Treatment for tuberculosis was started immediately, with good outcome.

DISCUSSION: Although a relationship between TB and COPD is likely, unfortunately it can not be assumed (2).

CONCLUSIONS: So, we should always treat tuberculosis as a life-threatening infectious disease which remains a major global health issue, especially due to dormant bacteria.

Reference #1: WHO 2010. Global tuberculosis control—surveillance, planning, financing. Geneva, Switzerland: WHO.

Reference #2: Allwood BW, Myer L, Bateman ED A Systematic Review of the Association between Pulmonary Tuberculosis and the Development of ChronicAirflow Obstruction in Adults. Respiration. 2013 May 3

DISCLOSURE: The following authors have nothing to disclose: Bianca Paraschiv, Claudia Lucia Toma, Stefan Dumitrache-Rujinski, Liliana Grigoriu, Ionela Nicoleta Belaconi, Codin Saon, Miron Alexandru Bogdan

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