Post-tuberculosis (TB) Unilateral Left Lung Damage: TB Misdiagnosis and Mismanagement

Abstract

The extent of lung damage post-tuberculosis (TB) infection varies greatly, resulting in impairment of pulmonary structure and/or function. We present a case of TB misdiagnosis and mismanagement in a 53-year-old black African male living with HIV on anti-retroviral therapy (ART) with post-TB unilateral left lung damage. He presented with a one-month history of intermittent symptoms of fever, night sweats, right-sided chest pain, exertion intolerance, and hemoptysis, and was commenced on anti-TB treatment (ATT) at a local clinic despite the two negative TB infection laboratory results. Further evaluation, later by TB specialists, showed an underweight male in no obvious respiratory distress (at the time of examination), normal vitals, positive Trail's sign, chest asymmetry, and a displaced apex beat. Radiological findings included a collapsed left upper lung with extensive fibrosis and mediastinal shift on chest X-ray. Chest CT scan findings revealed bronchiectasis, left lung collapse with left upper lobe cavitary lesion containing an irregular mass, shift of the mediastinum to the left, and compensatory right lung hyperinflation. Laboratory findings showed a normocytic anemia. Neisseria species was cultured in sputum. GeneXpert on sputum was negative (twice) for TB on this current evaluation. SARS-CoV-2 PCR was also negative. A pulmonary function test (PFT) using spirometry showed restrictive lung damage with forced vital capacity (FVC) (2.26 (47%)), forced expiratory volume (FEV₁) (2.01(50%), and FEV₁/FVC (88.93%) ratio. A diagnosis of post-TB lung disease (PTLD) was confirmed. The ATT was stopped, and the PTLD findings were communicated back to the staff at the TB/chest clinic where the patient was treated for TB. Based on the current laboratory results and symptoms, the patient was treated with fluconazole 200 mg orally once daily for two months, analgesics, mucolytics, azithromycin 500 mg orally once daily for three days, and supportive therapy. The patient was also reviewed routinely at the pulmonology clinic.

Keywords: post tuberculosis lung damage (ptld); pulmonary mycetoma; radiologic findings; spirometry; tuberculosis (tb).