This is a 51-year-old male patient without HIV infection.
He had high fever, hemoptysis, chest pain, severe malnutrition with a weight of 43 kg (looking and 8 kg under his normal weight), anemia (Hb 9 g/dl, general malaise 31%)
Pulmonary TB was detected by positive BK.
He underwent supervised treatment for 6 months, which he fulfilled regularly and without interruptions, despite which the positive BK persisted.
The patient continued therapy for three additional months with drugs used in the maintenance phase and was referred to our laboratory for resistance studies.
At that time, the patient did not present any respiratory symptoms, had recovered her body weight, and the laboratory parameters were within the normal range.
The chest X-ray performed at our institution showed a pathological image (extensive consolidation) that affected almost the entire left lung.
There was also left pulmonary retraction of the trachea and cardiomediastinum to the left, with elevation of the left hemidiaphragm and fibrosis of the vertebral bodies of the thoracic spine.
Located spaces also in the upper lobe of the left lung.
In the right lung, an area of hypertransparency with an increase in the cephalad diameter was observed.
This X-ray did not show significant changes with respect to the radiography performed at the time of diagnosis of TB, which did not help determine whether the patient still had active TB.
Two sputum samples were sent to BK and cultured in Lowenstein-Jensen and Stonebrink medium.
The BK was positive for both samples (+++) and negative for 10 bacilli per microscopic field.
After this time, two other samples were equally authenticated, resulting both BK positive (++).
Again, neither culture was positive.
It was then decided to suspend treatment after 9 months and two new sputum samples were collected, which were positive for BK, this time (+) and negative culture.
Finally, 12 months after the start of treatment, the BK became negative (two samples) and the culture remained negative.
Two years after starting treatment, the patient was asymptomatic and her body weight recovered.
It was concluded, therefore, that the absence of clinical manifestations, the normalization of the still persisting symptomatology and the nutritional recovery, together with the serial negative sputum cultures and the regular fulfillment of the treatment by the explosive bacilli were indicative.
