Ruijin Hospital, Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Chest Infections I
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM
INTRODUCTION: Thymoma of type B2 is one of anterior mediastinal mass which usally presents as very large tumors with high invasiveness. Pulmonary involvement and auto-immune disturbance can be observed before and after the surgical intervention. In this paper, we report a rare long-term complication of pulmonary tuberculosis post-thymectomy.
CASE PRESENTATION: A 69-year-old male presented with chronic cough, chest tightness, fever and weight loss. He had undergone thymectomy for a huge thymoma of type B2 five years previously through a median sternotomy. Recent computed tomography (CT)-scan showed aggressive and diffuse cavitating tuberculous infection affecting both lungs. Revision of old CT-scan revealed a progression of pulmonary infection after the surgery. The postoperative course was smooth and he was followed uneventfully within the first three years. He was not exposed to any tuberculous patients. He felt intermittent episodes of pyrexia and noticed recent loss of weight. He was hospitalized with aggravated dyspnea. Transcutaneous lung biopsy under guidance of CT scan demonstrated typical caseous necrosis surronded with epithelioid hyperplasia and Langhans giant cells indicating Mycobacterium tuberculosis. He reponded well to anti-tuberculous, anti-tussive treatment and nutritional support.
DISCUSSION: Tuberculous infection complicating follow-up of a thymectomy has rarely been reported before in the literature. This may be a coincidental finding or may have been attributed to decrease cellular immunity. Thymoma of type B2 is a common thymic tumor with high invasiveness. It usually grows slowly and can attain large size before the diagnosis is made. It can be associated with some autoimmune disorders and pulmoanry involvement, even during postexcision period. We should pay attention to the immune status evaluation and variety of pulmoanry tuberculosis radiological features.
CONCLUSIONS: The patients with post-excision of thymoma should be under regular surveillance with special attention to a potential complication of pulmonary tuberculosis.
Reference #1: Satoh H, Kagohashi K, Ohara G, et al. A case of thymoma and Mycobacterium intracellulare infection Kekkaku, 2012,87(11):701-705.
Reference #2: Thongprayoon C, Tantrachoti P, Phatharacharukul P, et al. Associated immunological disorders and cellular immune dysfunction in thymoma: a study of 87 cases from Thailand. Arch Immunol Ther Exp (Warsz), 2013,61(1):85-93.
DISCLOSURE: The following authors have nothing to disclose: Jian Ping Zhou, Qing Yun Li
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