A Rare Case of Post-Primary Tuberculosis Which Was Pathologically Diagnosed as Lipoid Pneumonia

Abstract

Min Yu,1,2,* Jiacheng Zhong,1,2,* Xueyong Bu,3,* Xinjuan Tan,1,2 Danting Zhan,1,2 Xiaoyi Hu,1 Yingying Gu,4 Jing Xu,5 Peize Zhang,6 Lingwei Wang1,2 1Shenzhen People’s Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, 518055, China; 2Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518055, China; 3Department of Radiology, Shenzhen Longgang District Maternity & Child Healthcare Hospital, Shenzhen, 518172, China; 4Department of Pathology, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China; 5Department of Pathology, Shenzhen People’s Hospital, Shenzhen, 518055, China; 6Department of Pulmonary Medicine & Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, China*These authors contributed equally to this workCorrespondence: Lingwei Wang, Email [email protected] Presentation: The patient was a middle-aged housewife who had been using the household spray for a long time, and the main symptoms were cough and sputum production. Chest CT showed lobar ground-glass opacities (GGOs) with small patchy consolidation in the right middle lobe (RML), specifically, lung tissue pathology showed a large number of foamy cells and scattered multinucleated giant cells. The patient received empirical anti-infective treatment, but no clinical improvement was observed. Laboratory tests, including smears and cultures of sputum, blood and bronchoalveolar lavage fluid (BALF), did not provide clear evidence for pathogenic microorganisms. Therefore, the presumptive diagnosis was exogenous LP (ExLP). After 28 days of prednisone treatment, her symptoms improved, but 2 months later, she presented with a worsening cough, and the GGOs had progressed into lobar consolidation. Transbronchial lung biopsy (TBLB) culture showed mycobacterium tuberculosis (MTB), and lung tissue pathology showed granulomatous inflammation. After anti-tuberculosis treatment, the consolidation in the right middle lobe was gradually absorbed, along with a considerable symptom improvement. The final diagnosis of the patient was MTB infection with an endogenous lipoid pneumonia (EnLP)-like presentation.Conclusion: The current case highlights that the MTB infection should be considered when pathology shows LP accompanied by scattered multinucleated giant cells.Keywords: mycobacterium infection, aetiology, pathological diagnosis

Keywords

• mycobacterium infection
• aetiology
• pathological diagnosis