Peculiarities of multidrug-resistant tuberculosis on the background of idiopathic pulmonary fibrosis (a clinical case report)

Abstract

Objective – familiarization of practitioners with the peculiarities of pulmonary multi-drug resistant tuberculosis (MDRT) in a patient with idiopathic pulmonary fibrosis (IPF) resulted from a long exposure to environmental factors at the workplace.

Materials and methods. The article deals with a clinical case of own observation of pulmonary MDRT development in a patient with IPF. The patient was hospitalized in the Pulmonary Tuberculosis Department No 3 (Department of Resistant Tuberculosis) of the Clinical Site of Phthisiology and Pulmonology Department of Zaporizhizhia State Medical Univercity in the CI “Zaporizhzhia Regional Tuberculosis Clinical Dispensary”.

The results of our own observations. Patient: male, 41 years, no medical history of tuberculosis. His work was associated with a harmful environmental factor within 7 years: dust in the workplace (refueling and repair of powder-type fire extinguishers). After 3 weeks of inpatient treatment, the patient died. The presented clinical case demonstrates the complexity of a life-time IPF diagnosis, which progression provoked the development of an equally serious disease, such as multi-resistant disseminated pulmonary tuberculosis and the prescription of antimycobacterial therapy. The cause of death was a progressive pulmonary fibrosis, and as a result, a progressively worsening pulmonary heart disease.

Conclusions. Practitioners should be especially vigilant and attentive while dealing with a patient having a history of harmful environmental factors exposure that may cause IPF development. It must be borne in mind that IPF may be asymptomatic for a long time resulting in increased risk for developing tuberculosis. This case confirms the literature data that the development of pulmonary MDRT in patients with untreated IPF leads to a rapid fatal outcome in the vast majority of cases (in this case it was 3 weeks).