Co-Existence of Pulmonary Tuberculosis and Interstitial Lung Disease in a Patient of Connective Tissue Disorder: A Case Report LD01-LD03
Nafees Ahmad Khan,
Department of TB and Respiratory Diseases, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
Pulmonary involvement is common in patients with systemic sclerosis. The most common underlying histology is NSIP. Disrupted immunity from the disease or associated medication may render such patients prone to develop tuberculosis infection.
A 55-year-old female patient presented with chief complaints of shortness of breath for 5 years which was gradually progressive, cough initially dry later with minimal expectoration for last 2 months, low grade fever for last 2 months. She also gave history of bluish discolouration of fingers tips on exposure to cold water. On examination there was restrictive mouth opening, thickened skin over hands, forearm, face, neck and trunk on pinching. Sclerodactyly was present with clubbing grade 2. On auscultation bilateral fine crepts were present. Serum ANA was highly raised and Scl 70 was positive. PFT was suggestive of restrictive ventilatory abnormality. Sputum smear for AFB was found to be positive. HRCT thorax was suggestive of NSIP. Patient was put on antituberculer treatment under DOTS category 1; nifedipine, pentoxyphylline and nitroglycerine gel was started for raynauds phenomenon. Chemotherapy for systemic sclerosis was given with cyclophosphamide infusion in 6 cycles every 4 weeks.