Pulmonary tuberculosis

Case contributed by Dr Margaret Nguyen

Presentation

Several months of productive cough, night sweats and unintentional weight loss. Recent travel to the South Pacific Islands. Heavy smoker.

Patient Data

Age: 60 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

X-ray

Chest x-ray shows a large cavitating lesion in the left upper zone. No pleural effusion.

CT

CT chest reveals a thin walled, irregular cavitating lesion at the left lung apex which measures approximately 6 x 4.5 x 4.5 cm. There are two intracavitary bodies which are attached to the lateral wall of the cavity. Surrounding the cavity, there is consolidation and ground glass opacities. There is mild left mediastinal lymphadenopathy. No hilar, supraclavicular or axillary lymphadenopathy.

There are no pleural effusions.

Case Discussion

Three sputum acid fast bacilli (AFB) smears were positive.

The patient subsequently had a bronchoscopy and Mycobacterium tuberculosis complex DNA was detected on GeneXpert on the bronchial washings.

He was commenced on standard quadruple tuberculosis treatment consisting of isoniazid, rifampin, pyrazinamide and ethambutol.

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