‘Stepladder Lung Cavities’ with ‘Starry Sky Pattern’ in HRCT Thorax with Constitutional Symptoms: A Strong Predictor of Active Pulmonary Tuberculosis

Patil, Shital; Dahiphale, Jayashree; Raka, Vipul; Narkar, Sanika; Choudhari, Shubham; Gondhali, Gajanan

doi:10.36346/sarjm.2023.v04i02.003

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…Pulmonary tuberculosis can have diverse presentations ranging from cavitation, consolidation, tumorous lesions, coin lesions, lower lung filed tuberculosis and endobronchial and miliary nodules [2][3][4][5][6][7][8][9][10][11][12]. Similarly, non-tuberculous pathologies can present with abnormalities such as consolidations, nodules, cavitations mimicking tuberculosis [2][3][4][5][6][7][8][9][10][11][12][13][14]. Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, non-tuberculous pathologies can present with abnormalities such as consolidations, nodules, cavitations mimicking tuberculosis [2][3][4][5][6][7][8][9][10][11][12][13][14]. Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14]. High risk factors for tuberculosis would be advanced age, malnutrition, pregnancy, steroids exposure, diabetes mellitus and immunosuppression [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14]. High risk factors for tuberculosis would be advanced age, malnutrition, pregnancy, steroids exposure, diabetes mellitus and immunosuppression [9][10][11][12][13][14]. Tuberculosis in advanced stage may cause cardiac dysfunction and systemic effects which will have poor outcome if timely treatment not received [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Recurrent Pleural Effusion in Drug Sensitive Extrapulmonary Tuberculosis: Marker of Immune Dysregulation!

Patil,

Patil

2023

SAR J Med

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Pleural effusion secondary to tuberculosis is second most common manifestation of extrapulmonary tuberculosis. Tuberculous pleural effusion is more frequently documented in India due to high TB burden setting and usually cured with universally available ATT as per NTEP program. Very few cases showed inadequate treatment response and these cases require addition of steroids to relive symptoms. Addition of steroids in management of TB pleural effusion is not routinely indicated and not recommended by NTEP as well. Clinical deterioration during antituberculosis therapy in patients whose cases have initially improved is known as a “paradoxical reaction.” In this case report, a 54-year teacher male presented with constitutional symptoms with right upper lobe nodular opacity with infiltrates treated empirically for community acquired pneumonia and progressed to left massive pleural effusion with respiratory distress diagnosed as case of Tuberculous pleural effusion by reporting raised ADA level and CBNAAT test results with MTB genome and negative Rifampicin (rpo-b) mutation. He is treated according to NTEP guided ATT schedule as per weight band in line with drug sensitive tuberculosis. He has shown good clinical and radiological response in first six weeks to ATT and later showed clinical and radiological worsening. We further reassessed and confirmed drug sensitive tuberculosis and continued same regimen. We have further evaluated for possibility of immune dysregulation in present case by doing TH1 and TH2 markers and observed TH1-TH2 dysregulation and also significantly raised IgE level. We have started oral steroids which were contoured till six weeks in tapering order along with ATT and documented significant improvement in clinical and radiological response. We have observed near complete resolution of pleural effusion after seven months and documented clinical and radiological cure after eight months of ATT. Paradoxical reaction is not uncommon, but needs prompt workup to rule out underlying drug resistant tuberculosis. Short course of steroids will give symptomatic relief in drug sensitive tuberculosis along with ATT. We recommend to rule out immune dysregulation in cases with drug sensitive recurrent pleural effusion in spite of acceptable adherence with good quality drugs for adequate duration which have showed excellent initial response to ATT.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recurrent Pleural Effusion in Drug Sensitive Extrapulmonary Tuberculosis: Marker of Immune Dysregulation!

Patil,

Patil

2023

SAR J Med

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“…The lung cavity is a gas-filled space within a zone of pulmonary consolidation or within a mass or nodule produced by the expulsion of a necrotic part of the lesion via the bronchial tree [1]. The pathophysiology of the lung can be due to many processes, such as suppurative necrosis, infarction (ischemic necrosis), cystic displacement of lung tissue, and malignant tumor desquamation [1]. Aspergillus causes various diseases, including pulmonary aspergillosis, rhinosinusitis, central nervous system aspergillosis, endocarditis, osteomyelitis, and endophthalmitis [2].…”

Section: Introductionmentioning

confidence: 99%

Aspergilloma in an Immunocompetent Host: A Case Report

AlShaheen,

Abuzied,

Aldalbahi

et al. 2023

Cureus

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Aspergillosis is a serious pathologic condition caused by Aspergillus that commonly affects immunocompromised patients. In recent years, it has been demonstrated that Aspergillus infection can cause a wide spectrum of pulmonary diseases, including allergic bronchopulmonary aspergillosis, chronic necrotizing aspergillosis, aspergilloma, and invasive aspergillosis. The characteristic computed tomography (CT) and pathologic findings of the various pulmonary manifestations of Aspergillus infection are illustrated and reviewed in this case report.Aspergillus niger is an infrequent infection that affects the lungs in severely immunosuppressed patients. In this paper, we report the case of a 50-year-old female with well-controlled type 2 diabetes mellitus who presented to the emergency department with a history of shortness of breath, cough, and weight loss. She denied any use of immunosuppressive medications. High-resolution CT revealed a large right upper lung cavitary lesion, and the sputum examination and bronchoalveolar lavage revealed Aspergillus niger and positive Aspergillus galactomannan. In conclusion, immunocompetent hosts are rarely affected by aspergilloma with lung cavities. We recommend conducting a retrospective data registry on unreported aspergilloma cases in immunocompetent patients to understand the clinicopathological behavior and improve management.

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“Miliary lung parenchymal opacities” as presenting feature of metastatic papillary type of thyroid malignancy: It’s not tuberculosis always!

Patil,

Mirza,

Gondhali

2024

GJHSR

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Pulmonary tuberculosis (TB) is the most common cause of mortality and morbidity in South East Asia due to infective causes and tops the list of all infectious etiologies in India. Radiological presentations in pulmonary TB are diverse with the most common in them, which are nodules, consolidation, cavitation, and lung parenchymal destruction with or without collapse and consolidation. In this case report, a 31-year-old female presented with constitutional symptoms with miliary opacities in chest X-ray without microbiological evidence for TB in smear microscopy or nucleic acid amplification tests. She was treated as a case of miliary TB with antituberculosis treatment (ATT) on two occasions in the past 2 years as an “X-ray-positive case” on the basis of symptoms and chest radiology findings. She was never shown any clinical and radiological response in the past 1½ years in spite of satisfactory ATT adherence and compliance. After retrospective analysis of this case at our center, we have documented worsening of radiological findings and chest high-resolution computed tomography conformed miliary nodules and not typical miliary mottling favoring TB. We have noted right thyroid enlargement with a nodule in contrast tomography of neck. Fine-needle aspiration cytology confirmed as papillary carcinoma of the thyroid. We have confirmed this case as miliary metastasis due to primary thyroid malignancy. Miliary metastasis should be considered in cases with atypical radiological and clinical presentations with negative microbiological workup. No empirical ATT should be offered in the era of highly sensitive nucleic acid amplification tests and the term “X-ray-positive with negative microbiological tests” should be phased out.

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‘Stepladder Lung Cavities’ with ‘Starry Sky Pattern’ in HRCT Thorax with Constitutional Symptoms: A Strong Predictor of Active Pulmonary Tuberculosis

Cited by 4 publications

References 26 publications

Recurrent Pleural Effusion in Drug Sensitive Extrapulmonary Tuberculosis: Marker of Immune Dysregulation!

Recurrent Pleural Effusion in Drug Sensitive Extrapulmonary Tuberculosis: Marker of Immune Dysregulation!

Aspergilloma in an Immunocompetent Host: A Case Report

“Miliary lung parenchymal opacities” as presenting feature of metastatic papillary type of thyroid malignancy: It’s not tuberculosis always!

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