CRA44 A LINGERING SHADOW: UNVEILING MYCETOMA IN A POST-TUBERCULOSIS LUNG

Priyadarsini A1, U.N. Daut1, T Abdul Aziz2
Department of Medicine, University Putra Malaysia, Serdang (Selangor), Malaysia

Background 

Pulmonary tuberculosis (PTB) poses significant clinical challenges and can lead to long-term complications, despite successfully completing treatment. This is due to predisposition of residual lung damage leading to complications, such as the development of aspergilloma, also known as mycetoma, which in turn can cause symptoms such as hemoptysis. This case illustrates the challenges in diagnosing and managing post-tuberculosis sequelae and the utmost importance in effective management and long-term follow-up for PTB patients to prevent severe outcomes. 

Case report 

This is a case of a 27-year-old woman who presented with recurrent episodes of hemoptysis. She had a history of PTB diagnosed at 18 years of age and has completed treatment course. Current PTB workup were negative. A contrast enhanced computed tomography (CECT) of the thorax performed and revealed multiple cavitary lesions in the upper lobes of bilateral lungs, with rounded opacities, highly indicative of mycetoma. Due to the nature of the mycetoma and its associated risks, surgical intervention deemed unsuitable. She was then treated with prolonged course of Voriconazole (An antifungal medication) for a year as an alternative treatment approach.

This case highlights the complexities of managing long-term complications following PTB, even after completing treatment. It emphasizes the necessity of vigilant follow-up and to consider non-tuberculous etiologies, such as mycetoma especially in individuals who presents with acute respiratory symptoms, however yields a negative PTB workup. The role of prolonged antifungal treatment becomes pivotal, particularly in cases where surgery is not feasible. Prompt diagnosis and effective medical management are crucial in preventing severe complications and enhancing patient outcomes.