Tuberc Respir Dis.  2010 Jul;69(1):52-55.

A Case of Atypical Distribution of Pulmonary Tuberculosis in Bedridden Patient with Quadriplegia

• Hwang HG
• Jung EJ
• Lim GI
• Yang SB
• Im HH

Abstract

Pulmonary tuberculosis has intermediate prevalence in Korea. It is known that tuberculosis infection predominantly involves the upper lobes, based on the fact that multiplication of Mycobacterium tuberculosis is favored in areas with decreased pulmonary blood flow, impaired lymphatic drainage, and high oxygen tension. We report this case of a 40-year-old man who was brought to our hospital with hemoptysis and dyspnea. Prior to admission, the patient had been in a bedridden state for 15 years due to an injury of the cervical spine 4~5. A 3-Dimensional computed tomography showed predominantly longitudinal distribution of centrilobular nodules along the anterior chest wall, in the left lung. MTB-PCR and AFB culture of bronchial washing fluid revealed pulmonary tuberculosis. This case shows that long-standing supine posture and decreased motion of the anterior chest wall may change the distribution of preferential infection site of Mycobacterium tuberculosis in the lung, resulting in a ventral predominance of tuberculosis infection in the quadriplegic patient.

Keyword

Tuberculosis; Quadriplegia; Tomography, X-Ray Computed

MeSH Terms

Adult
Drainage
Dyspnea
Hemoptysis
Humans
Korea
Lung
Mycobacterium tuberculosis
Oxygen
Posture
Prevalence
Quadriplegia
Spine
Thoracic Wall
Tomography, X-Ray Computed
Tuberculosis
Tuberculosis, Pulmonary
Oxygen

Figure

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  Figure 1 Chest X-ray shows (A) peribronchial patchy infiltration in left upper and lower lung fields on admission, and (B) much cleared lung field after antituberculosis treatment for 9 months.

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  Figure 2 Sagittal section of lung setting shows (A) patchy and centrilobular infiltration prominently in anterior chest wall of left lung field, and (B) much cleared lung field after antituberculosis treatment for 9 months.

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  Figure 3 Coronal section of lung setting shows (A) patchy and centrilobular infiltration in line along anterior chest wall of left lung field, and (B) much cleared lung field after antituberculosis treatment for 9 months.

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