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A Case of Vanishing Cavities
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A6553 - A Case of Vanishing Cavities
Author Block: L. Khorsheed; Respiratory, Mater Misericordiae Hospital, Dublin, Ireland.
Authors
L Khorsheed, B McCullagh
Mater Misericordiae Hospital, Dublin, Ireland
Case Report
We present the case of a 37 year old male from Pakistan who attended our Emergency Department with a history of weight loss, occasional night sweats and fatigue for 6 months. He denied suffering from cough or haemoptysis. He had not received antibiotics for his chest. He was an active smoker.His Chest Xray demonstrated bilateral infiltrates with cavitation along with bilateral hilar adenopathy. CT Thorax reported multifocal regions of consolidation with miliary type nodular infiltrates and cavitation, highly suspicious for mycobacterium tuberculosis (TB). Sputum and early morning urine were negative for acid-fast bacilli. We proceeded to bronchoscopy with bronchoalveolar lavage and transbronchial biopsies. Lavage was negative for TB stain with no micro-organism grown on culture. Transbronchial biopsies demonstrated noncaseating granulomas. In spite of the absence of confirmatory microbiology on initial testing there remained a high suspicion for TB. He therefore had a mediastinoscopy, again demonstrating noncaseating granulomas most consistent pathologically with sarcoidosis. We elected to follow up in clinic with CT scans and supporitive management alone. His CT thorax 6 months later showed resolution of lesions with involution of the cavities. His symptoms settled and he started putting on weight.
Author Block: L. Khorsheed; Respiratory, Mater Misericordiae Hospital, Dublin, Ireland.
Authors
L Khorsheed, B McCullagh
Mater Misericordiae Hospital, Dublin, Ireland
Case Report
We present the case of a 37 year old male from Pakistan who attended our Emergency Department with a history of weight loss, occasional night sweats and fatigue for 6 months. He denied suffering from cough or haemoptysis. He had not received antibiotics for his chest. He was an active smoker.His Chest Xray demonstrated bilateral infiltrates with cavitation along with bilateral hilar adenopathy. CT Thorax reported multifocal regions of consolidation with miliary type nodular infiltrates and cavitation, highly suspicious for mycobacterium tuberculosis (TB). Sputum and early morning urine were negative for acid-fast bacilli. We proceeded to bronchoscopy with bronchoalveolar lavage and transbronchial biopsies. Lavage was negative for TB stain with no micro-organism grown on culture. Transbronchial biopsies demonstrated noncaseating granulomas. In spite of the absence of confirmatory microbiology on initial testing there remained a high suspicion for TB. He therefore had a mediastinoscopy, again demonstrating noncaseating granulomas most consistent pathologically with sarcoidosis. We elected to follow up in clinic with CT scans and supporitive management alone. His CT thorax 6 months later showed resolution of lesions with involution of the cavities. His symptoms settled and he started putting on weight.
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