LEARNING MODULE TITLESUBTITLE

HISTORY OF PRESENT ILLNESS

An 18 year-old woman with no past medical history and no known risks for TB presents with several months of cough, weight loss, and fatigue.

• She had no underlying medical problems• No known contacts with MDR-TB patients.

INITIAL CXR

DIAGNOSIS

• She was determined to be at risk for TB based on her symptoms and underwent testing.

• Her sputum was found to be smear positive with 3+ AFB.

CLINICAL COURSE

• Two months after starting therapy, the patient had worsening shortness of breath and cough. – She was compliant with her TB treatment.

• She came to the hospital and had sputum that was smear + and an CXR that showed the following findings.

The CXR showed a collapsed left lung. The patient underwent a bronchoscopy to visualize the airway to determine the problem in the left lung.

FOLLOW-UP CXR

Bronchoscopy showed tuberculosis at the end of the airway (endobronchial TB) in the left airway. The patient underwent dilation of the airway and was continued on first-line drugs.

BRONCHOSCOPY

CLINICAL COURSE

• The patient continued her first line drug regimen with good adherence and compliance

• After 5 months on therapy, her sputum smear remained positive (1+/2+).

• Sputum culture and drug susceptibility testing showed resistance to INH and Rifampicin, meeting the diagnosis for MDR-TB.

MDR-TB DIAGNOSIS

• The patient was switched to second-line drugs for MDR regimen, and she has steadily improved while on treatment.

• Her last CXR was ***• Her last sputum smear/culture was ***• She has *** months left on treatment

TEACHING POINTS

• What are the classic risk factors for MDR-TB?• In patients without these classic risk factors,

when would you think of testing for MDR-TB?• What are the symptoms and signs of collapsed

lobes of the lung?• What is the treatment and follow-up for

endobronchial TB?