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A 21-Year-Old Immune-Competent Man With Recurrent Cough
Xiangning Yuan1, Mao Jiang2, Lijian Tao3
1Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Chest
|April 8, 2020
Summary
A young man with a persistent cough initially suspected to have tuberculosis (TB) did not improve with standard anti-TB therapy. Further investigation was needed to determine the cause of his prolonged respiratory symptoms.
Area of Science:
- Pulmonology
- Infectious Diseases
- Medical Diagnostics
Background:
- A 21-year-old male presented with a 5-month history of nonproductive cough.
- Initial workup included elevated inflammatory markers, positive purified protein derivative (PPD) and T.SPOT.TB tests, and chest CT findings suggestive of tuberculosis.
Observation:
- Despite empiric anti-tuberculosis therapy (ethambutol, isoniazid, pyrazinamide, rifapentine), the patient's cough persisted for 4 months.
- Bronchoscopy revealed mucosal swelling and congestion, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) showed nonspecific necrosis.
Findings:
- Initial diagnostic tests indicated tuberculosis (TB), but the patient's lack of response to standard anti-TB treatment suggested an alternative diagnosis.
- Negative acid-fast bacillus smear results further complicated the initial diagnosis.
Implications:
- This case highlights the importance of considering alternative diagnoses when patients with initial signs suggestive of tuberculosis do not respond to empiric anti-TB therapy.
- Persistent cough and inconclusive diagnostic findings necessitate a comprehensive re-evaluation for accurate diagnosis and effective treatment.
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