Clinical example of effective treatment of a patient with a combination of fibrous-cavernous tuberculosis and chronic aspergillosis of the right lung

Abstract

ntroduction. The combination of destructive tuberculosis and chronic pulmonary aspergillosis remains a pressing and understudied problem. Respiratory tuberculosis is a significant risk factor for bronchopulmonary aspergillosis in 40–72% of cases. The current treatment strategy for pulmonary tuberculosis and bronchopulmonary aspergillosis is governed by clinical guidelines. However, the issues of surgical treatment tactics in complicated forms of the combination of active tuberculosis and pulmonary aspergillosis require discussion and remain relevant at present. Material and methods. A clinical case of complex treatment of a patient with a combination of fibrous-cavernous tuberculosis and chronic aspergillosis of the right lung is described. Patient S., 42 years old, became ill with infiltrative tuberculosis of the right lung in August 2008. On the background of a 9-month anti-tuberculosis chemotherapy according to the I regimen she was cured and in 2012 was removed from the dispensary registration. In February 2018, an episode of pulmonary hemorrhage (volume 200 ml) occurred, and was stopped by conservative methods. At the follow-up examination, tuberculosis recurrence was verified in the right lung with the formation of fibrous-cavernous lesion. On the background of the repeated 6-month course of treatment according to the I regimen no dynamics was obtained, pulmonary hemorrhage of the Ia stage recurred regularly. In September 2018, the patient was hospitalized to SPb NIIF. Pre-examination revealed chronic pulmonary aspergillosis. Voriconazole therapy was started, and correction of the ongoing antituberculosis therapy was carried out, taking into account drug interaction. Surgical treatment was indicated. Results. On 09.25.2018, an upper bilobectomy was performed on the right side. There were no intraoperative complications. The operation was completed by draining the pleural cavity with two drains and suturing the thoracotomy wound. Postoperative period without complications. In order to correct the volume of hemithorax, an artificial pneumoperitoneum of 1000 ml was applied. The drains were removed on the 4thand 5th days after surgery, the surgical wound healed by primary tension. At the follow-up examination after five years, there was no evidence of disease recurrence or late surgical complications. Conclusion. Providing medical care to patients with a combination of tuberculosis and pulmonary aspergillosis requires the organization of full-fledged primary diagnosis and routing of patients to a specialized hospital. A complex approach to treatment allows for successful treatment outcomes with minimal risks.