Recurrent pulmonary tuberculosis associated with neoplastic process and severe comorbidities

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.