Clinical and paraclinical particularities in bilateral infiltrative pulmonary tuberculosis with destruction

Abstract

Background. Early detection and prompt initiation of antiTB treatment represent the cornerstone of therapeutic success, especially in progressive forms of tuberculosis with multiple localizations and a high complication rate. This also helps prevent the persistence of an active infectious reservoir in the community. Objective(s). To present a complex clinical case of bilateral infiltrative pulmonary tuberculosis with destructive lesions and extrapulmonary involvement in a socially vulnerable patient. Materials and methods. The case of a 50-year-old male patient, hospitalized as scheduled in the Phthisiopneumology Clinical Municipal Hospital, Chișinău, with newly diagnosed bilateral infiltrative pulmonary TB with unilateral destruction (evolutionary phase), was evaluated. Clinical, laboratory, imaging, and functional investigations were performed. Results. The examinations revealed intoxication syndrome – CRP 109.84 mg/L, ESR 40 mm/h, LYM 29–31%, HGB 105 g/L; and pronounced bronchopulmonary syndrome – mucopurulent sputum, moderate fever, dyspnea mMRC-3, SpO₂ 94%, RR 22. Multiple bilateral peribronchovascular changes (nodular opacities) with destruction zones of 0.5–1.0 cm were identified. AFB was negative; Xpert MTB/RIF was positive and sensitive (sputum and pus from fistula). The TB process had multiple extrapulmonary sites including soft tissue and pleura, with formation of a pleuro-thoracic fistula. Specific RIPE therapy was initiated, alongside symptomatic treatment. Conclusion(s). This case confirms the necessity of thorough and multidisciplinary evaluation in patients suspected of having TB with both pulmonary and extrapulmonary manifestations. The use of molecular testing (Xpert MTB/RIF) allowed for rapid diagnosis and initiation of appropriate treatment.