Pulmonary tuberculosis with COPD
Patient is heavy smoker, presented with cough with expectoration and chest pain since 6 month with AFB +++ in sputum microscopy.
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There are multiple thick walled cavitatory lesions noted in bilateral upper lobes along with patchy ground glass nodules and branching centrilobular nodules (tree in bud), cystic bronchiectatic changes and subpleural emphysematous bullae. suggestive of infective etiology most likely pulmonary tuberculosis with chronic obstructive disease changes
In both the conditions, pulmonary TB and COPD there is destruction of pulmonary extracellular matrix. The micobacterium cell wall antigen lioparabinomannan (LAM) is responsible for matrix metalloproteinases (protease) and immune mediated breakdown of extracellular matrix collagen. Smoking also enhances protease and elastase activity in the extracellular matrix thus result in destruction of collagen. In long standing tubercular infections COPD may be a complication1.