Follow up of Drug-Resistant Pulmonary Tuberculosis Patients in a DRTB Center in First Fifteen Months of Treatment

Background and Objective: Multidrug-resistant tuberculosis (MDR-TB) is defined as resistant to both INH and Rifampicin with or without resistance to other first-line antitubercular drugs. The aim of the study was to assess the sputum culture conversion rate during first 12 months of treatment in drug-resistant TB patients, to assess the impact of comorbid illnesses and other factors on culture conversion by following up the patients up to 15 months after initiation of treatment. Materials and Methods: This was a prospective study comprising of 142 diagnosed patients of drug-resistant TB admitted in this center from April 2014 to March 2015 for treatment initiation, excluding extrapulmonary TB and already diagnosed extensively drug-resistant tuberculosis (XDR-TB). After pretreatment evaluation, standard second-line antitubercular drug (CAT-IV) was started. Patients were followed up in first 15 months of treatment. Results of sputum culture for mycobacteria at 3rd, 4th, 5th, 6th, 7th, 9th and 12th months after treatment initiation were analyzed. Results: Sputum culture for mycobacteria was converted negative within one year in 95 cases (67%); whereas 18 patients died during follow up, 27 defaulted and 2 patients switched over to CAT-V after development of extended drug-resistance during follow up. Conclusion: Though drug-resistant tuberculosis (DRTB) is one of the biggest challenges to public health program in India, treatment with standardized second-line drugs under RNTCP have a favorable outcome as indicated by sputum culture conversion of as many as 67% of patients within one year in this study.

It′s easy to miss complicated hydatid cyst of lung

A 60-year-old female presented with pneumonitis of right lower zone. CT scan revealed mass like lesion with multiple air pockets. FNAC and ultrasound confirmed the diagnosis as isolated active pulmonary hydatid cyst, which is not common finding in adult population

Diffuse parenchymal lung disease in a case of chronic arsenic exposure

A 42-year-old housewife, the resident of rural part of West Bengal, presented with gradually progressive exertional dyspnea associated with a dry cough for last 3 years clinical features were suggestive of diffuse parenchymal lung disease (DPLD). Her chest X-ray posteroanterior view and high resolution computed tomography scan of the thorax showed bilateral patchy ground glass opacities and reticulonodular pattern. Search for the etiology revealed classical skin findings of chronic arsenic exposure in the form of generalized darkening and thickening of skin and keratotic lesions over the palms and soles and classical raindrop pigmentation over leg which was present for last 7 years subsequently her bronchoalveolar lavage fluid, hair, nail, and drinking water showed significant amount of arsenic contamination. By exclusion of all known causes of DPLD, we concluded that it was a case of DPLD due to chronic arsenic exposure. To the best of our knowledge, only few case report of DPLD in chronic arsenicosis has been reported till date

Pulmonary sarcomatoid carcinoma: An uncommon entity in a 40 years female

A middle-aged female presented with nonpleuritic chest pain with progressive dyspnea and unmeasured weight loss and anorexia for last 4 months. The patient had pallor, clubbing, but no peripheral lymphadenopathy. Clinically, vesicular breath sound was diminished over anterior, posterior, and lateral aspect of the right hemithorax with a dull note on percussion. Chest radiography showed homogenous opacity involving the right hemithorax with blunting of right costophrenic angle without contralateral shifting of the lower mediastinum. Contrast-enhanced computed tomography (CT) thorax revealed a large mixed density mass lesion occupying the entire right hemithorax with peripheral contrast enhancement. The lesion narrowed the right pulmonary artery and insinuated the adjacent mediastinum, but no evidence of pleural nodularity. CT guided fine-needle aspiration cytology from the mass was inconclusive. Tru-cut biopsy from the mass showed spindle-shaped cells, with nuclear pleomorphism and mitotic figures, arranged in interlacing fascicles. The histopathology was suggestive of spindle cell neoplasm. Immunohistochemistry (IHC) showed pancytokeratin (AE1/3), cytokeratin 7, vimentin, and epithelial membrane antigen positivity, whereas immunonegativity to thyroid transcription factor-1, WT-1, and calretinin. The radiological picture with IHC pattern favored the diagnosis of pulmonary sarcomatoid carcinoma

Spontaneous esophagopleural fistula in a high-risk individual (trumpet blower)

A middle-age male patient, trumpet blower by occupation, presented with progressive dyspnea with chest heaviness since 2 weeks and low grade fever since 1 week. It started with sudden severe retrosternal chest discomfort and episodic vomiting while practicing trumpet blowing. Patient was toxic with high fever, tachycardia, and tachypnoea. Clinicoradiologically, patient was diagnosed as left-sided hydropneumothorax. Intercostal chest (ICD) tube was inserted at left 5th. intercostal space at midaxillary line following which pus and air came out. Pleural fluid was acidic with high amylase level and polymicrobial growth. Repeat chest X-ray showed partial resolution of left-sided hydropneumothorax. From 4th Day, food particles were noticed in the drainage bag. For screening, 0.1% sterile methylene blue was given orally which came in ICD tube and bag within 24 hours. Subsequently, barium swallow esophagus, CT thorax with oral and intravenous contrast, and upper gastrointestinal endoscopy confirmed left-sided esophagopleural fistula

Pulmonary arteriovenous malformation: An uncommon disease with common presentation

A 45-year-old male presented with massive hemoptysis, clubbing in all limbs, disproportionate hypoxia and persistent ill-defined shadow in left lower zone in chest radiograph since his childhood. The patient received empirical anti-tuberculosis treatment and the chest X-ray finding was misinterpreted as tuberculoma. Subsequently, CT pulmonary angiography proved it to be a case of a simple type solitary pulmonary arteriovenous malformation with a saccular aneurysm in left lower lobe

A young lady presented with limited pulmonary Wegener′s granulomatosis

A 19 year old female college student presented with fever, dry cough, chest pain, blood tinged sputum with subsequent development of polyarthralgia with radiological evidence of bilateral multiple unevenly distributed pulmonary nodular opacities with cavitation. There was no other systemic involvement and the patient was cytoplasmic antineutrophil antibody (c-ANCA) positive with more than four times the normal upper limit of anti PR3 antibody. Excellent response to oral steroid with antimicrobial agent “trimethoprim – sulphamethoxazole” was noted