Tuberk Toraks 2014;62(4):322-323
Recurrent bilateral pneumothorax complicating miliary tuberculosis with bone marrow involvement
322
Pneumothorax is a rare complication of miliary tuberculosis (TB). Pneumothorax is potentially life threatening in association with miliary TB. The diagnosis of pneumothorax may be delayed. The possible mechanism is case ationor necrosis of subpleural miliary nodule sand their subsequent rupture (1). This report describes a case with recurrent bilateral pneumothorax complicating miliary TB with bone marrow involvement.
Thirty four years old male patient admitted to clinic with complaints of cough, anorexia, weight loss. Chest X-ray showed diffuse micronodular in filtrations in both lungs. White blood cell count: 1800, Hgb: 8.6 platelet count: 69.000, AST: 288 U/L ALT: 81 U/L. Sputum smears were found positive for acid-fast bacilli three times.
Epithelioid histiocytes cluster containing minimal necrosis and giant cells were observed at the bone marro was piration biopsy. Miliary TB with bone marrow involvement was defined depending on clinic-radiologic and laboratory findings.
On the 20th day of anti-TB treatment, pneumothorax of left lung occurred. Chest tube thoracostomy was done.
One day later, total pneumothorax of right lung occurred and right chest tube thoracostomy was done (Figure 1). Left and right sided pneumothorax significantly resorbed. But total pneumothorax of right lung recurred again. Right hemithorax was reexpanded later.Liver function tests and pancytopeni aim proved. The patient still remains drug free control.
Although miliary pattern and pneumothorax are rare radiological features in pulmonary TB, their incidences are nearly 1.3% and 1.5%, respectively (2). The diagnosis of
pneumothorax may be delayed (3). The possible mecha- nism of pneumothorax in miliary TB is formation of small areas of confluent subpleural miliary nodules.
These nodules undergo caseous necrosis with subse- quent rupture in to the pleural space. This will lead to air leak in to pleural cavity, causing pneumothorax (1).
Recurrent bilateral pneumothorax
complicating miliary tuberculosis with bone marrow involvement
doi • 10.5578/tt.7866
Tuberk Toraks 2014;62(4):322-323
Geliş Tarihi/Received: 03.07.2014 • Kabul Ediliş Tarihi/Accepted: 15.07.2014
EDİTÖRE MEKTUP LETTER TO THE EDITOR Abdullah ŞİMŞEK1
Müjgan GÜLER1
Hülya ÇELENK ERGÜDEN1 Ruhsar OFLUOĞLU1 Nermin ÇAPAN1
1 Department of Chest Diseases, Ankara Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
1 Ankara Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Kliniği, Ankara, Türkiye
Dr. Abdullah ŞİMŞEK
Ankara Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Kliniği, ANKARA - TURKEY
e-mail: abdullahsimsek1@yahoo.com.tr
Yazışma Adresi (Address for Correspondence)
Tuberk Toraks 2014;62(4):322-323
Şimşek A, Güler M, Çelenk Ergüden H, Ofluoğlu R, Çapan N.
323 Frequently pneumothorax is not seen at the begin-
ning of therapy but is seen during the course of treat- ment when it is least expected (4,5). In the present case, bilateral pneumothorax occurred during anti-
TB treatment. Right sided pneumothorax also recurred again. As a conclusion, although pneumothorax in miliary TB is rare, it can be recurrent. During anti-TB treatment, worsening should make us think of a pneumothorax.
CONFLICT of INTEREST None declared.
RE FE REN CES
1. Tasar MA, Bostanci I, Aslan S, Yılmaz R, Dallar Y. Recurrent pneumothorax in an infant with miliary tuberculosis.
Tuberk Toraks 2005;53:394-6.
2. Aktoğu S, Yorgancioglu A, Cirak K, Köse T, Dereli SM.
Clinical spectrum of pulmonary and pleural tuberculosis: a report of 5,480 cases. Eur Respir J 1996;9(10):2031-5.
3. Sharma N, Kumar P. Military tuberculosis with bilateral pneumothorax: A rare complication. Indian J Chest Dis Allied Sci 2002;44:125-7.
4. Wammanda RD, Ameh EA, Ali FU. Bilateral pneumothorax- complication of miliary tuberculosis in children: Case report and review of literature. Ann Trop Paediatr 2003;23:149-52.
5. Mert A, Bilir M, Akman C, Ozaras R, Tabak F, Ozturk R, et al. Spontaneous pneumothorax: A rare complication of military tuberculosis. Ann Thorac Cardiovasc Surg 2001;7:45-8.
Figure 1. Chest X-Ray
