Tuberculosis - "mask" of pulmonary edema

Abstract

Background. Cardiogenic pulmonary edema is a medical emergency, which requires prompt management. Case report. A 28 years old female with pregnancy 22 weeks, without anamnestic of cardiovascular pathology, but with periodic syncopal conditions caused by stress and chronic tonsillitis. Without any tuberculosis contact. The patient has been consulted by the family doctor with moderate pain in the bilateral lumbar region, fever 39, pollakiuria, dysuria and macrohematuria and she was admitted to the district hospital. In the blood test highlighted changes for inflammatory syndrome, at the urinalysis - insignificant proteinuria and leukocyturia. Was initiated antibacterial treatment with cephalosporins generation III. Over 24 hours the condition of the patient with the sudden exacerbation manifested by dyspnoea and hemoptysis (sputum with fresh blood sprays). X-Ray changes - bilateral pneumonia. The patient was transferred to the pneumology clinic, ATI section with the clinical diagnosis: Bilateral community pneumonia, severe evolution. Suspected of pulmonary TB? Chronic bilateral pyelonephritis, exacerbation. Pregnancy 22 weeks. From the objective data we can emphasize SaO2 at 87% TA 100/50 mmHg, FCC - 115 b / min, auscultation in lungs - crackles bilaterally. At auscultation of the heart - systolo-diastolic murmur at the apex and systolic at the tricuspid valve. Sputum and urine testing at BAAR, GeneXpert – negative. Electrocardiography - sinus rhythm, AEC - intermediate, FCC - 120 b / min. Ultrasound of the heart with moderate mitral stenosis (GP: 16). Insufficiency VM gr. III, Insufficiency VT gr. IIIII. Systolic pressure in AP 37 mmHg. FA - 57%. Cardiac surgeon has confirmed the diagnosis: Rheumatic heart disease with mitral- tricuspid defect. After treatment with antibiotic therapy, diuretics and calcium channel antagonists -radiological changes disappeared on the 3rd day after treatment. Conclusions. According to the literature, valvulopathy during pregnancy is detected mostly at late pregnancy term (> 20 weeks), in about 3-5% of cases. Sometimes this pathology can wear the "mask" of other pathologies, which can delay the optimal treatment.