LEARNING MODULE TITLE SUBTITLE

HISTORY OF PRESENT ILLNESS An 18 year-old woman with no past medical history and no known risks for TB presents with several months of cough, weight loss, and fatigue. She had no underlying medical problems No known contacts with MDR-TB patients.

INITIAL CXR

DIAGNOSIS She was determined to be at risk for TB based on her symptoms and underwent testing. Her sputum was found to be smear positive with 3+ AFB.

CLINICAL COURSE Two months after starting therapy, the patient had worsening shortness of breath and cough. – She was compliant with her TB treatment. She came to the hospital and had sputum that was smear + and an CXR that showed the following findings.

The CXR showed a collapsed left lung. The patient underwent a bronchoscopy to visualize the airway to determine the problem in the left lung. FOLLOW-UP CXR

Bronchoscopy showed tuberculosis at the end of the airway (endobronchial TB) in the left airway. The patient underwent dilation of the airway and was continued on first-line drugs. BRONCHOSCOPY

CLINICAL COURSE The patient continued her first line drug regimen with good adherence and compliance After 5 months on therapy, her sputum smear remained positive (1+/2+). Sputum culture and drug susceptibility testing showed resistance to INH and Rifampicin, meeting the diagnosis for MDR- TB.

MDR-TB DIAGNOSIS The patient was switched to second-line drugs for MDR regimen, and she has steadily improved while on treatment. Her last CXR was *** Her last sputum smear/culture was *** She has *** months left on treatment

TEACHING POINTS What are the classic risk factors for MDR-TB? In patients without these classic risk factors, when would you think of testing for MDR-TB? What are the symptoms and signs of collapsed lobes of the lung? What is the treatment and follow-up for endobronchial TB?