SESSION TITLE: Infectious Disease Student/Resident Case Report Posters III
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: There is a large body of literature from the developing world to describe chronic airway obstruction in patients with prior tuberculosis, however current reports of this phenomenon outside of Latin America, Africa and Asia are sparse. We report a patient who presented to our clinic in New York with airflow obstruction due to resolved tuberculosis.
CASE PRESENTATION: A 47 year old man presented to our pulmonary clinic for dypsnea on walking 2 blocks. His past medical history was notable for tuberculosis at age 18 treated with one year of antimicrobial therapy. The patient was born in Puerto Rico and immigrated to the US at age 21. He was a lifelong non-smoker and denied exposure to asbestos, silica or biomass fuel burning. Vital Signs were notable for oxygen saturation of 83% at rest while breathing ambient air. Physical exam revealed decreased breath sounds in all lung fields without wheeze or crackles. Pulmonary function testing showed FEV1 of 15% predicted, FVC 38% predicted and FEV1/FVC ratio 31%. FVC increased post-bronchodilator but FEV1 and FEV3 did not. Total lung capacity was 68% predicted, residual volume was 144% predicted and diffusing capacity was 28% predicted. CT of the chest is shown.
DISCUSSION: Pulmonary function studies in this patient showed severe combined obstructive-restrictive ventilatory impairment. Along with the patient’s history and imaging, this finding is consistent with the residual effects of tuberculosis. Tuberculosis related airflow obstruction is thought to be due to bronchial stenosis, gross distortion of the airway, extrinsic bronchial compression from lymphadenopathy and parenchymal lung destruction resulting in airway collapse. Prior to the widespread use of anti-tuberculosis therapy in developed nations, chronic airway obstruction was frequently seen in patients with resolved granulomatous disease. Though there is a large body of literature from developing nations that highlights this phenomenon, it is no longer commonplace for clinicians in the developed world to encounter tuberculosis related chronic airway obstruction.
CONCLUSIONS: Clinicians should be aware that patients with tuberculosis related chronic airway obstruction exist in practice. This diagnosis should be considered when evaluating patients who come from regions where tuberculosis is endemic or in older patients from developed countries.
Reference #1: Jordan TS, Spencer EM, Davies P (2010) Tuberculosis, bronchiectasis and chronic airflow obstruction. Respirology 15:623-8
Reference #2: Ehrlich RI, Adams S, Baatjies R, Jeebhay MF (2011) Chronic airflow obstruction and respiratory symptoms following tuberculosis: a review of South African studies. Int J Tuberc Lung Dis 15: 886-891
Reference #3: Radovic M, Ristic L, Stankovic I, Pejcic T, Rancic M, Ciric Z, Dinic-Radovic V. (2011). Chronic Airlow Obstruction Syndrome Due to Pulmonary Tuberculosis Treated with Directly Observed Therapy-A Serious Changes in Lung Function. Med Arch; 65(5):265-269
DISCLOSURE: The following authors have nothing to disclose: Luis Quintero, Daniel Fein, Michael Silverberg, Albert Miller
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