A CASE OF PANCOAST SYNDROME IN TB

Abstract

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Tuberculosis is one of the most common systemic infectious disease, and a major public health problem all over the world. It has several forms of presentation and clinical manifestations. Here we present an interesting clinical manifestation of Tuberculosis as Pancoast Syndrome. CASE PRESENTATION: A 55 year old male, smoker for past 30 years, presented with cough with expectoration, left shoulder pain and weakness of left upper limb of 6 months duration. He had irregular treatment for pulmonary tuberculosis two years ago. On examination he had partial ptosis of left eye, enophthalmos, miosis, ipsilateral anhydrosis, and tenderness in left supraclavicular region, wasting of left upper limb muscles. Sputum examination was positive for Acid fast bacilli. Cartridge based Nucleic Acid Amplification Test (CBNAAT) of sputum confirmed Rifampicin sensitive Mycobacterium Tuberculosis. Chest radiograph and CT Chest showed fibrocavitary changes, Cavitary consolidations predominantly involving right lung and mass like lesion in left apical lobe with erosion of left first rib. Histopathological examination with CT guided biopsy of the mass like lesion was negative for malignancy but showed caseous granulomatous inflammation. DISCUSSION: Pancoast syndrome1 refers to a constellation of symptoms of Brachial Neuralgia, Horner’s syndrome and atrophy of muscles of ipsilateral upper limb. Pancoast syndrome is commonly associated with Pancoast tumor of Squamous cell carcinoma , recently adenocarcinoma has emerged as commonest. Other conditions that may result in Pancoast syndrome are (1) Other tumors - primary chest wall and metastatic tumors, pleural mesothelioma, hematologic malignancies, (2) infectious and inflammatory lung diseases – tuberculosis, aspergillosis, echinococcosis, actinomyces and lung abscesses, inflammatory pseudotumor, amyloid nodules and (3) vascular lesions - carotid pseudoaneurysm, hemangioma.These conditions can invade and destruct the apical bony skeleton of the thorax, producing similar clinical and radiographic picture. CONCLUSIONS: We conclude that clinicians need to be aware of the variable manifestations of Tuberculosis. Reference #1: Pancoast HK. Superior pulmonary sulcus tumor: tumor characterized by pain Horner’s syndrome, destruction of bone and atrophy of hand muscles. JAMA 1932;19:1391-6. Reference #2: White HD, White BA, Boethel C, et al. Pancoast’s syndrome secondary to infectious etiologies: a not so uncommon occurrence. Am J Med Sci 2011;341:333-6 Reference #3: Beshay M, Roth T, Stein RM, et al. Tuberculosis presenting as Pancoast tumor. Ann Thorac Surg 2003;76:1733-5 DISCLOSURES: No relevant relationships by ALLWYN VIJAY GOWRI SHANKAR, source=Web Response No relevant relationships by Sagindar Samaraj, source=Web Response