Non Resolving Pneumonia: Managed well in a 62-year-old
in Max Super Speciality Hospital, Dehradun
Feb 01 , 2023
A 62-year-old female patient was admitted with persistent shadow on her chest radiograph on left lower zone. She gave history of off and on mild fever along with dry cough for the past 2 months. Before coming to our hospital, she consulted multiple general physicians with multiple courses of antibiotics with no clinically significant improvement. She denied history of contact with any tuberculosis patient.
Sputum AFB stain was done at some other center and was negative. On examination, she was of average built, was afebrile, chest auscultation revealed crepts on left side. Routine investigations were within the normal limits. As part of diagnostic work-up, CT chest was done which revealed consolidation of left upper lobe with alveolar shadows in lower lobe.
To establish diagnosis, bronchoscopy was done and biopsy and BAL fluid was sent for investigations. BAL fluid was positive for AFB stain as well as for Genexpert with no Rifampicin resistance. Endobronchial biopsy showed epitheloid cell granulomas. Patient was started on anti-tuberculosis treatment. On follow-up visit in OPD, she reported marked improvement in symptoms and her X-ray chest showed significant resolution of shadows.
Sputum AFB stain was done at some other center and was negative. On examination, she was of average built, was afebrile, chest auscultation revealed crepts on left side. Routine investigations were within the normal limits. As part of diagnostic work-up, CT chest was done which revealed consolidation of left upper lobe with alveolar shadows in lower lobe.
To establish diagnosis, bronchoscopy was done and biopsy and BAL fluid was sent for investigations. BAL fluid was positive for AFB stain as well as for Genexpert with no Rifampicin resistance. Endobronchial biopsy showed epitheloid cell granulomas. Patient was started on anti-tuberculosis treatment. On follow-up visit in OPD, she reported marked improvement in symptoms and her X-ray chest showed significant resolution of shadows.
Non-resolving Pneumonia is a common problem encountered in clinical practice, an early diagnosis and correct treatment is the key towards treatment success. In Tuberculosis, endemic countries like India high index of suspicion should be kept in cases of non-resolving
Pneumonia with sputum smear for AFB negative but clinical symptoms suggestive of Tuberculosis. Because of the high yield of bronchoscopy, it is very useful and safe diagnostic tool for evaluation of non-resolving Pneumonia. With early diagnosis and correct treatment, life threatening complications can be avoided.
Pneumonia with sputum smear for AFB negative but clinical symptoms suggestive of Tuberculosis. Because of the high yield of bronchoscopy, it is very useful and safe diagnostic tool for evaluation of non-resolving Pneumonia. With early diagnosis and correct treatment, life threatening complications can be avoided.
To summarise, non-resolving Pneumonia represents a great clinical diagnostic difficulty along with multiple uncertain diagnostic possibilities. Bronchoscopy is a great tool and investigation of choice in ensuring correct diagnosis in such patients.
