To treat or not to treat tuberculosis –clinical decision making in patients with previous pulmonary tuberculosis using 18F-FDG PET/CT

Gunar Günther; Nebal Abu- Hussain; Peter M. Keller; Reto Guler; Sandra L. Mukasa; Karen Wolmarans; Friedrich Thienemann

Respiratory Medicine Case Reports (Jan 2023)

To treat or not to treat tuberculosis –clinical decision making in patients with previous pulmonary tuberculosis using 18F-FDG PET/CT

Gunar Günther,
Nebal Abu- Hussain,
Peter M. Keller,
Reto Guler,
Sandra L. Mukasa,
Karen Wolmarans,
Friedrich Thienemann

Affiliations

Gunar Günther: Department of Pulmonology and Allergology, Inselspital Bern, Bern University Hospital, University of Bern, Switzerland; Department of Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia; Corresponding author. Department of Pulmonology and Allergology, Inselspital Bern, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
Nebal Abu- Hussain: Department of Pulmonology and Allergology, Inselspital Bern, Bern University Hospital, University of Bern, Switzerland
Peter M. Keller: Institute for Infectious Diseases, University of Bern, Bern, Switzerland
Reto Guler: International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology, Faculty of Health Sciences, University of Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, South Africa
Sandra L. Mukasa: General Medicine & Global Health (GMGH), Cape Heart Institute, Faculty of Health Science, University of Cape Town, South Africa; Department of Medicine, Faculty of Health Science, University of Cape Town, South Africa
Karen Wolmarans: General Medicine & Global Health (GMGH), Cape Heart Institute, Faculty of Health Science, University of Cape Town, South Africa; Department of Medicine, Faculty of Health Science, University of Cape Town, South Africa
Friedrich Thienemann: General Medicine & Global Health (GMGH), Cape Heart Institute, Faculty of Health Science, University of Cape Town, South Africa; Department of Medicine, Faculty of Health Science, University of Cape Town, South Africa; Department of Internal Medicine, University of Zürich, Switzerland

Journal volume & issue: Vol. 46
p. 101932

Abstract

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Post-tuberculosis (TB) radiological changes and symptoms can mimic TB. PCR-based diagnostic tests can show positive results, suggesting the presence of Mycobacterium tuberculosis DNA in the absence of viable bacteria. We present a case with two episodes of previous TB. Despite workup including trace to low positive PCR results, after performing sputum analysis, bronchoalveolar lavage analysis, cyto-brush and 18F-FDG PET/CT guided transthoracic biopsy, no culturable mycobacteria were detected. 18F-FDG PET/CT showed a high metabolic activity of the biopsied lesions. More accurate strategies and tools in patients with previous TB and positive PCR results are required to make appropriate treatment decisions.

Published in Respiratory Medicine Case Reports

ISSN: 2213-0071 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: http://www.journals.elsevier.com/respiratory-medicine-case-reports/

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