SPONTANEOUS PNEUMOTHORAX: AS AN INITIAL PRESENTATION OF PULMONARY TB IN A TEENAGER

Abstract

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Pulmonary TB should be consider to be a highly probable diagnosis in a child who was hospitalized for spontaneous pneumothorax especially in a developing world. CASE PRESENTATION: This is a case of a 17 year old, male, Filipino, from Quezon City, admitted for the first time due to a recurrent right-sided chest pain even when at rest associated with shortness of breath, aggravated by deep breathing, relieved by rest. DISCUSSION: TB is the most common infectious cause of death worldwide in 2015 especially in a resource-limited setting such as Philippines. Although almost every lung disease can result in secondary spontaneous pneumothorax(SSP), chronic obstructive pulmonary disease remains the most common cause of SSP. In 1 series study in Spain, pulmonary TB was the second most common cause of SP after COPD. In primary spontaneous pneumothorax (PSP) ,the lung expands and the air leak ceases within 3 days while in SSP, the mean time for the lung to expand is 5 days and in approximately 20% of patients, the lung remains unexpanded or an air leak persists after 7 days. Our patient was admitted due to a massive pneumothorax, which was initially thought as PSP since he was known to be previously healthy, who appeared tall and slim, with sudden onset of chest pain while at rest, which were a classic presentation of PSP. However, after taking a thorough history and physical examination, patient revealed a previous exposure and treatment of pulmonary tuberculosis, he was underweight at the time of admission. Furthermore, the persistence of pneumothorax despite being in a chest tube of 7 days, with the presence of fibrosis on initial chest xray and chest ct scan, suggested a secondary cause of pneumothorax. One study showed that 42% of patients who initially presented with pneumothorax on admission were later diagnosed to have an active Tb. Therefore, pulmonary TB should be consider to be a highly probable diagnosis. This finding highlights the necessity of performing bacteriologic studies, particularly sputum smear for acid-fast bacilli in patients who are hospitalized for pneumothorax. Another study, revealed that a total of 872 patients with SP were treated with 5.4% of whom had SSP secondary to TB. Also during this period, 2,089 cases of active TB were treated. Of the 47 cases with SSP secondary to TB, 21 presented with active TB at the moment of producing SSP (positive culture for Mycobacterium tuberculosis) and 26 with inactive residual TB. CONCLUSIONS: Pulmonary TB should be included in differential diagnosis in a child who was admitted for a spontaneous pneumothorax because Tuberculosis plays an immense health problem in the developing world and remains a health care challenge in the developed world affecting virtually any organ system in the body. It is a great mimicker as its manifestations can simulate numerous other diseases across the body systems. Reference #1: Organization WH: Global Organization Tuberculosis Report. Geneva: World Health Organization, 2016. Reference #2: 2.Chia-Hung Chen, Pigtail catheter drainage for secondary spontaneous pneumothorax Article in QJM: monthly journal of the Association of Physicians 99(7):489-91 · August 2006. Reference #3: 3.Masoud Shamaei MD et al, TuberculosisAssociated Secondary Pneumothorax: A Retrospective Study of 53 Patients, Respiratory care 56(3):298-302 · March 2011 DISCLOSURES: No relevant relationships by Mary Ruth Crabajal, source=Web Response