A Rare Case of Post-Primary Tuberculosis Which Was Pathologically Diagnosed as Lipoid Pneumonia

Abstract

Case Presentation

The patient was a middle-aged housewife who had been using the household spray for a long time, and the main symptoms were cough and sputum production. Chest CT showed lobar ground-glass opacities (GGOs) with small patchy consolidation in the right middle lobe (RML), specifically, lung tissue pathology showed a large number of foamy cells and scattered multinucleated giant cells. The patient received empirical anti-infective treatment, but no clinical improvement was observed. Laboratory tests, including smears and cultures of sputum, blood and bronchoalveolar lavage fluid (BALF), did not provide clear evidence for pathogenic microorganisms. Therefore, the presumptive diagnosis was exogenous LP (ExLP). After 28 days of prednisone treatment, her symptoms improved, but 2 months later, she presented with a worsening cough, and the GGOs had progressed into lobar consolidation. Transbronchial lung biopsy (TBLB) culture showed mycobacterium tuberculosis (MTB), and lung tissue pathology showed granulomatous inflammation. After anti-tuberculosis treatment, the consolidation in the right middle lobe was gradually absorbed, along with a considerable symptom improvement. The final diagnosis of the patient was MTB infection with an endogenous lipoid pneumonia (EnLP)-like presentation.

Conclusion

The current case highlights that the MTB infection should be considered when pathology shows LP accompanied by scattered multinucleated giant cells.

Keywords:

• mycobacterium infection
• aetiology
• pathological diagnosis

Abbreviations

PPTB, post-primary tuberculosis; LP, lipoid pneumonia; GGOs, lobar ground-glass opacities; RML, right middle lobe; BALF, bronchoalveolar lavage fluid; ExLP, exogenous lipoid pneumonia; TBLB, transbronchial lung biopsy; MTB, mycobacterium tuberculosis; EnLP, endogenous lipoid pneumonia.

Ethics Approval and Consent to Participate

The study was approved by the research ethics committee of the Third People’s Hospital of Shenzhen (reference number: 2021-015-02). Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Consent for Publication

Written informed consent for publication was obtained from the participant.

Disclosure

Yu, Zhong and Bu are co-first authors. The authors declare that they have no competing interests.

Additional information

Funding

This work was supported by the Shenzhen Science and Technology Program (KCXFZ202002011008256). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.