Cystic lung disease in tuberculosis: An unusual presentation
A13-year-old female patient presented with the complaints of fever for 1 month duration and shortness of breath for 10 days. She also complained of decreased appetite and significant loss of weight for the same duration. On examination, patient's pulse rate was 130 beats/min, blood pressure was 100/70 mmHg, respiratory rate was 48/min. On auscultation chest revealed bilateral crepitations. Examination of the other systems was unremarkable. Arterial blood gas (ABG) analysis showed paO2:42 mmHg, pCO2:44 mmHg, HCO3:27.1 mmol/L, pH 7.406. Chest X-ray showed bilateral diffuse reticular shadows. A contrast enhanced computed tomography thorax [Figures and ] showed multiple thin walled cysts seen in both the lungs (left > right; upper lobe > lower lobe); diffuse ground glass opacities and centrilobular nodules in both lung fields.\nPatient was intubated and ventilated in view of respiratory failure and impending respiratory arrest In the Intensive Care Unit bronchoscopy was performed through the endotracheal tube and washings taken. Transbronchial lung biopsy was performed and sent for histopathological examination, which showed granulomatous inflammation consistent with tuberculosis. Bronchial washings sent for Mycobacterium tuberculosis culture was positive.\nPatient was treated with antitubercular regimen (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol) with steroids (1 mg/kg). The fever subsided and the patient could be weaned off the ventilator within 10 days of starting the above treatment. Patient was discharged after 1 week. At the time of discharge ABG showed paO2:73 mmHg, paCO2:28.5 mmHg, pH:7.446. Steroids were continued for 1 month after which it was tapered gradually over 1 month. Anti-tubercular drugs were continued for 6 months. At the end of treatment, ABG showed paO2:95 mmHg, paCO2:39 mmHg, pH:7.39. Repeat high resolution computed tomography thorax [Figures amd ] showed a reduction in the number and size of cysts in both the lung fields with decrease in diffuse lung opacities and nodular lesions.