Caso 21

Abstract

It presents a case report of a female patient, 53 years old, former smoker, with diabetes mellitus and systemic hypertensive cardiovascular disease, hospitalized at the Hospital das Clínicas of the Federal University of Minas Gerais due to oligoproductive cough, dyspnea on exertion moderate, low fever, and weight loss (2 kg) for 2 months. The subacute evolution of cough, dyspnea, fever and weight loss suggests tuberculosis (TB) as a possible diagnosis, but AFB research in sputum was negative; however, due to the relatively low sensitivity of this test, it requires the analysis of at least two samples to ensure proper test reliability. X-rays should be ordered for every patient with clinical suspicion of pulmonary TB. However, up to 15% of cases of pulmonary TB do not show radiological changes, which is more common in immunosuppressed patients. In patients with positive bacilloscopy, this test allows the exclusion of associated lung disease, such as lung cancer in smokers. HRCT is not routinely indicated, but it is useful for diagnosing atypical pulmonary or extrapulmonary TB, which is common in HIV-infected patients. Furthermore, although not specific to TB, the demonstration of centrilobular nodules associated with the “tree-in-bud” pattern suggests an active process and helps in the differential diagnosis with sequelae of the disease.