Abstract:
Background. Pulmonary tuberculosis (TB) common recurs in immunocompromised
patients with multiple comorbidities, severe nutritional impairment. The coexistence of
pulmonary oncological pathology complicates differential diagnosis, negatively impacts
prognosis, requiring a multidisciplinary, complex management strategy.
Objective(s). To present a clinical case of pulmonary tuberculosis relapse associated with
bronchopulmonary cancer and severe comorbidities with difficulties in therapeutic
management and unfavorable outcome.
Materials and methods. A case of a 68-year-old male with history of tuberculosis and
gastrectomy, hospitalized with bronchopulmonary syndrome was retrospective analyzed.
Diagnosis was based on imaging findings, Xpert MTB/RIF molecular test (positive from
bronchoalveolar lavage, sensitive to rifampicin), FBS, microbiological tests and
interdisciplinary consultations.
Results. TB relapse was confirmed by Xpert MTB/RIF test of bronchial lavage despite
negative AFB sputum smears and cultures. Thoracic imaging exams revealed a progressive
broncholobular lesion in left lung, suspicious for neoplasm (T2M2Mx). Laboratory tests
showed grade II anemia (HGB 77–102 g/L), inflammatory syndrome - CRP 45–61 mg/L, ESR
40–52 mm/h and hypokalemia (2.6 mmol/L). Diagnosed conditions included bilateral
pneumonia with Klebsiella pneumoniae, exacerbated chronic bronchitis, chronic
pancreatitis, and severe cachexia. Treatment included RIPE regimen, broad-spectrum
antibiotics, antifungals, electrolyte correction and nutritional support.
Conclusion(s). This case highlights the need for rapid molecular testing in the diagnosing
of the recurrent TB. The overlapping neoplastic process and multiple comorbidities require
an integrative interdisciplinary approach and continuous clinical monitoring to ensure
optimal therapeutic outcome.
