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Progressive fibrotic interstitial lung disease emerging after pulmonary tuberculosis: a retrospective observational
Yasuhiro Ito1, Seiichi Miwa1, Tomoko Oshima1
1Department of Respiratory Medicine, National Hospital Organization Tenryu Hospital, 4201-2 Oro, Hamana-ku, Hamamatsu, Shizuoka, 434-8511, Japan.
Background:
Post-tuberculosis lung disease (PTLD) is recognized as a localized sequela characterized by fibrotic scarring, bronchiectasis, or volume loss. However, whether a progressive fibrotic interstitial lung disease (ILD) phenotype can emerge after pulmonary tuberculosis (TB) remains unclear.
Methods:
We conducted a retrospective observational study of HIV-negative patients with pulmonary TB at a single tertiary hospital. Baseline and longitudinal high-resolution computed tomography (HRCT) images were reviewed to identify ILD, interstitial lung abnormalities (ILA), indeterminate ILA (iILA), and radiologic evidence of progression. Patients were classified into a progressive fibrotic phenotype (PF) or non-PF, and their clinical and radiologic features were compared.
Results:
Among the 255 patients, baseline HRCT identified ILD in 26, ILA in 18, and iILA in 5 patients. Sixteen patients underwent imaging follow-up for > 2 years, of whom 7 (ILD: 2, ILA: 3, iILA: 2; 2.7% of the total cohort) were classified into the PF group. Patients in the PF group had a higher Mycobacterium tuberculosis burden and a longer time to sputum smear and culture conversion. Radiologically, patients with PF developed pleuroparenchymal fibroelastosis-like lesions. None of the patients without baseline interstitial abnormalities developed ILD.
Conclusion:
A progressive fibrotic ILD may emerge as part of PTLD, particularly in patients with baseline interstitial abnormalities, a high mycobacterial burden, and delayed sputum conversion.
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