CRA46 DISSEMINATED TUBERCULOSIS COMPLICATED WITH PNEUMOTHORAX WITH PERSISTENT AIR LEAKS AND CAECAL PERFORATION

Nor Safiqah Sharil1, Nik Nuratiqah Nik Abeed2, Boon Hau Ng2, Andrea Ban Yu-Lin2
1 Faculty of Medicine and Health Science, University Sains Islam Malaysia, Internal Medicine Unit, Negeri Sembilan, Malaysia
2 Faculty of Medicine, University Kebangsaan Malaysia

Introduction

Tuberculosis (TB) continues to be a formidable infectious disease, especially in endemic areas, leading to severe complications. This case report discusses a case of disseminated TB presenting casuing pneumothorax with persistent air leaks with and ileocecal perforation, highlighting the patient’s extraordinary recovery.

Case Description 

An 18-year-old male was admitted with acute respiratory distress, chronic cough, and significant weight loss. Initial assessments revealed right-sided pneumothorax and respiratory failure. Pulmonary TB was diagnosed through chest radiograph and confirmed with positive sputum acid-fast bacilli (AFB) smear and TB culture. Complications included tension pneumothorax and pneumomediastinum, requiring mechanical ventilation and emergency chest tube insertion. A contrast-enhanced CT scan of the thorax identified a bronchopleural fistula. Despite immediate intervention and anti-TB therapy, persistent air leaks were noted. Due to high ventilation settings and hemodynamic instability, surgical repair was deemed unfeasible. The patient also developed lower gastrointestinal bleeding, diagnosed as ileocecal TB perforation confirmed via histopathology showing granulomatous cells with positive AFB. Surgical management included exploratory laparotomy, peritoneal washout, and limited hemicolectomy. Following four months of anti-TB treatment and pleural drainage, the persistent air leak resolved without surgical intervention. The patient was discharged in the fifth month and completed 12 months of anti-TB therapy. At the one-year follow-up, the patient reported an active lifestyle with no symptoms suggesting recurrent TB.

Conclusion 

This case underscores the potential for full recovery through early diagnosis, comprehensive treatment, and thorough management in disseminated TB to address severe complications like pneumothorax and gastrointestinal perforation. The combination of anti-TB treatment and supportive care can lead to successful recovery, as demonstrated by this patient's outcome.