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Amit G. Kachalia, Erik Perez, Kinjal A. Kachalia, Jaspreet Kaur, Rahman Habibur
(Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens, NY, USA)
Med Sci Case Rep 2016; 3:48-51
Pneumatoceles usually develop as sequel of acute bacterial pneumonias and rarely as a complication of tuberculosis. Pseudotumors are usually inflammatory. We report the first case of a mucoid pseudotumor complicating a pneumatocele and one of the few reports of a pneumatocele that developed as a complication of pulmonary tuberculosis.
CASE REPORT: A 53-year-old female smoker with family history of lung cancer presented with chronic cough, weight loss, and fever. QuantiFERON-TB Gold was positive and a chest x-ray revealed a large homogeneous density in the left upper lobe. Computerized tomography of the chest showed pneumonia and a pneumatocele formation. Bronchoalveolar lavage grew acid-fast bacilli and Penicillium species; trans-bronchial biopsies showed nonspecific inflammation. The patient received treatment for Class 3 tuberculosis with symptomatic improvement. Later, she presented with cough and hemoptysis. Surveillance imaging showed increasing soft-tissue density and nodules in the area of previous consolidation, suggestive of a solid tumor. Positron emission tomography (PET) showed the affected area was minimally avid with central hypo-attenuation. Several weeks later, the patient returned with complete resolution of her symptoms after her protracted cough lead to expectoration of copious sputum and a large ball-like mucous formation. Repeat imaging showed clearing of the soft-tissue density and reappearance of pneumatocele. The patient has remained asymptomatic.
CONCLUSIONS: Symptoms that relapse with radiological presentation would have warranted an extensive malignancy workup. This first case report of a mucoid pseudotumor complicating a pneumatocele case reminds us to include tuberculosis as one of the etiological organisms for pneumatoceles, and highlights the importance of continued surveillance, especially in smokers.