A Rare Case of a Tuberculosis Patient with Sarcoidosis.

BACKGROUND: Sarcoidosis and tuberculosis are chronic diseases that rarely occur concomitantly. We present the case of a 39-year-old woman with microbiological confirmation of pulmonary tuberculosis and concomitant sarcoidosis. Four weeks after corticosteroid therapy for sarcoidosis was introduced we had positive findings of mycobacterium culture from bronchial aspirate. Based on these results, corticosteroid therapy was discontinued and the patient received anti-tuberculosis therapy for six months as required by the national guidelines. During this period, new nodes on face, nose, and ear appeared and the patient was diagnosed with skin sarcoidosis. The patient received colchicine and corticosteroids as per the national guidelines. CONCLUSION: In cases of diagnostic uncertainty between sarcoidosis and tuberculosis we should administer corticosteroid therapy until we have microbiological confirmation of mycobacterium culture.

Clinical Aspects and Evolution under Current Treatments on Pulmonary Alveolar Phospholipoproteinosis Patients.

A 34-year-old female smoker (4 packs a year), with the following symptoms: dry cough, moderate dyspnea, fatigue, night sweats and no exposure to respiratory poisoning or contact with tuberculosis. Clinical findings at admission: normal temperature, Hippocratic fingers and cyanosis, diminished bilateral breath sounds, fine bilateral rattling respiratory sounds, rhythmic cardiac noises, oxygen saturation 95%, pulse 87, blood pressure 125/80 mm Hg. Chest computed tomography describes infiltration images of intra-alveolar and intra-bronchial with matte glass pattern, confluent and stretched across all lung segments. Pulmonary biopsy: preserved pulmonary architecture, thick alveolar septs and terminal bronchioles, alveoli and macrophages loaded with lipoprotein material. Bronchial aspirate: negative BAAR, no tumor cells. Bronchoalveolar lavage: opalescent, abundant PAS + appearance. total cell numbers - 4.3 million, macrophages - 34.1%, lymphocytes - 56.9%, neutrophils - 10%, eosinophils - 0.4%, epithelial cells - 33%.The treatment option chosen for this case was total bronchoalveolar lavage for therapeutic purposes. The patient had a rapid favourable evolution and at discharge was recommended a periodic imaging and functional control. Key Messages: Bronchoalveolar lavage is the optimal diagnostic method. Moderate/severe forms, total bronchoalveolar lavage is recommended. Systemic corticotherapy or immunosuppression is not indicated. GM-CSF administered subcutaneously or by nebulization. Rituximab/plasmapheresis are under evaluation. Pulmonary transplantation is indicated in patients who do not respond to therapeutic bronchoalveolar lavage repeated 6-12 months.

A 50-year-old male with fever, cough, dyspnoea, chest pain, weight loss and night sweats.

Can you diagnose this case of a 50-year-old male with a 10-week history of high fever, mucopurulent cough, dyspnoea, right-sided chest pain, weight loss and night sweats http://ow.ly/QFEM30h26GE.