Clinical Manifestations and Treatment-Outcome in Patients with Pulmonary Tuberculomas.

Abstract

Background: Sparse data are available regarding the clinical manifestations and diagnosis of pulmonary tuberculoma and its response to antituberculosis treatment. Methods: Retrospective study of case records of patients diagnosed to have pulmonary tuberculoma during the period 1998−2008 at a tertiary care teaching hospital in south India. Results: Their mean age was 44±4.2 years; there were 8 females. Nine patients [all males] were bidi smokers [21.4±8.6 pack years]. All of them were human immunodeficiency virus−negative. Co−morbid conditions included diabetes mellitus [n=6]; hypertension [n=4] and chronic obstructive pulmonary disease [n=3]. Most common presenting symptoms were cough [n=16], sputum [n=14], fever [n=9], anorexia [n=7], fatigue [n=6]; diagnosis was made on routine check−up in 6 patients. The diagnosis was estbalished by computed tomography [CT]−guided fine needle aspiration cytology [n=12]; CT−guided true−cut biopsy [n=4] sputum smear and mycobacterial culture [n=4], bronchoalveolar lavage smear [n=2]. Six patients had multiple lesions. Mean transverse and longitudinal diameters were 3.4±1.8 and 2.8±1.9 cm respectively. Standard daily supervised short−course antituberculosis treatment [n=16] and DOTS under the Revised National Tuberculosis Control Programme [n=6] resulted in disappearance in 18 and significant regression of the lesions in 4 patients. Paradoxical worsening of lesions while on treatment occurred in 4 patients. Treatment had to be extended to 9 months in 5 patients on daily regimen and 2 patients on DOTS. None of the patients receiving DOTS developed drug−induced liver injury [DILI] compared with 4 patients on daily treatment who developed DILI. Conclusions: CT−guided FNAC and biopsy are useful in the diagnosis of pulmonary tuberculomas. Response to antituberculosis treatment is good; but, paradoxical worsening of lesions may occur while on treatment. This abstract is funded by: None. Am J Respir Crit Care Med 179;2009:A3202 Internet address: www.atsjournals.org Online Abstracts Issue