[A case of pulmonary tuberculosis presenting with infected bulla]

A case of pulmonary tuberculosis manifested as infected bulla complicating with tuberculous pneumonia is reported. A 63-year-old male visited our hospital because of chest X-ray abnormality detected by his home doctor. He complained of pyrexia and productive cough. Chest X-ray showed large bulla with air-fluid level, associated with surrounding infiltration at right upper lobe. On the diagnosis of infected bulla empirical antibiotic therapy was started on out-patient basis and continued after admission, but chest X-ray findings worsened, although subjective symptoms were once relieved. Surgical intervention was recommended, but after short interval pulmonary infiltrates rapidly worsened and expanded to other lobes. Sputum was reexamined and Mycobacterium, later proved as Mycobacterium tuberculosis with DNA probe method, was detected in the sputum specimen. Anti-mycobacterial drugs were administered and subjective symptoms, laboratory, and chest X-ray findings improved. Infected bulla caused by Mycobacterium tuberculosis is rare, but when it is resistant to common empirical therapy, Mycobacterium tuberculosis should be considered as one of its causative agents.