IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES Pulmonary Tuberculosis Presenting as Organizing Pneumonia Min-Han Hsieh1 and Chun-Yu Lin1,2 1 Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and 2Graduate Institute of Medicine, Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Figure 1.
An 80-year-old man without HIV infection presented with fever, progressive dyspnea, and productive cough for 5 weeks. Computed tomography scans revealed progression of consolidation bilaterally over a 25-day interval despite treatment with antibiotics, including amoxicillin/clavulanic acid combined with azithromycin, followed by levofloxacin, piperacillin/tazobactam combined with amikacin, and then tigecycline (Figures 1A and 1B). The results of the microbiological examination of bronchoalveolar lavage fluid (aerobic culture, mycobacterial culture, and Ziehl-Neelsen staining) were all negative. Thoracoscopic biopsy of the left lower lobe was performed for pneumonitis of uncertain etiology. The specimen revealed prominent nodules of loose, myxoid fibrous tissue filling the alveolar spaces and local bronchioles (Masson bodies, indicated by the arrows in Figure 1C, Biebrich scarlet solution stain), interstitial fibrosis, and foci of foamy macrophages in the lung parenchyma, which were consistent with organizing pneumonia. Ziehl-Neelsen staining of the resected lung specimen demonstrated acid-fast bacilli (indicated by the arrows in Figure 1D), and culture yielded Mycobacterium tuberculosis resistant to isoniazid. This unusual case documents pulmonary tuberculosis presenting as organizing pneumonia. n Author disclosures are available with the text of this article at www.atsjournals.org.
Author Contributions: M.-H.H. wrote the draft; C.-Y.L. read and edited the draft; C.-Y.L. took the responsibility for this manuscript. Am J Respir Crit Care Med Vol 189, Iss 9, p e63, May 1, 2014 Copyright © 2014 by the American Thoracic Society DOI: 10.1164/rccm.201304-0722IM Internet address: www.atsjournals.org
Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences
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Figure 1.
An 80-year-old man without HIV infection presented with fever, progressive dyspnea, and productive cough for 5 weeks. Computed tomography scans revealed progression of consolidation bilaterally over a 25-day interval despite treatment with antibiotics, including amoxicillin/clavulanic acid combined with azithromycin, followed by levofloxacin, piperacillin/tazobactam combined with amikacin, and then tigecycline (Figures 1A and 1B). The results of the microbiological examination of bronchoalveolar lavage fluid (aerobic culture, mycobacterial culture, and Ziehl-Neelsen staining) were all negative. Thoracoscopic biopsy of the left lower lobe was performed for pneumonitis of uncertain etiology. The specimen revealed prominent nodules of loose, myxoid fibrous tissue filling the alveolar spaces and local bronchioles (Masson bodies, indicated by the arrows in Figure 1C, Biebrich scarlet solution stain), interstitial fibrosis, and foci of foamy macrophages in the lung parenchyma, which were consistent with organizing pneumonia. Ziehl-Neelsen staining of the resected lung specimen demonstrated acid-fast bacilli (indicated by the arrows in Figure 1D), and culture yielded Mycobacterium tuberculosis resistant to isoniazid. This unusual case documents pulmonary tuberculosis presenting as organizing pneumonia. n Author disclosures are available with the text of this article at www.atsjournals.org.
Author Contributions: M.-H.H. wrote the draft; C.-Y.L. read and edited the draft; C.-Y.L. took the responsibility for this manuscript. Am J Respir Crit Care Med Vol 189, Iss 9, p e63, May 1, 2014 Copyright © 2014 by the American Thoracic Society DOI: 10.1164/rccm.201304-0722IM Internet address: www.atsjournals.org
Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences
e63
