Respir Case Rep. 2018; 7(2): 90-96 | DOI: 10.5505/respircase.2018.82787

Tuberculous Lymphadenitis of Hilar Lymph Nodes as a Cause of Right Middle Lobe Syndrome: A Case Report

Shital PATIL¹, Mazhar Mirza^2
1Pulmonary Medicine Department, Mimsr Medical College, Latur
²Internal Medicine, Mimsr Medical College Latur Maharashtra India

Right middle lobe syndrome (RMLS) is a rare but important clinical entity that is characterized by recurrent or chronic collapse of the middle lobe of the right lung, but which may also involve the lingula of the left lung. In this case report, a 52-year-old female presented with typical constitutional symptoms of tropical disease like cough, fever, and shortness of breath. Chest radiology documented RMLS and bronchoscopy was key to the evaluation of this case, as a sputum examination was inconclusive. Transbronchial needle aspiration (TBNA) of the lymph node and bronchoalveolar lavage (BAL) specimens were tested and Mycobacterium tuberculosis (MTB) of the hilar lymph nodes on the right side was confirmed using the GeneXpert MTB/RIF assay. Four anti-tuberculosis treatment drugs were initiated and maintained for a total of 8 months with steroids as an adjunct in tapering dosages for 4 weeks. Complete clinical and radiological recovery was documented and confirmed bronchoscopically. A high index of suspicion is important when managing RMLS cases and all possible measures should be taken to confirm diagnosis.

Keywords: RMLS (Right middle lobe syndrome), tuberculous lymphadenitis, Bronchoscopy, BAL, Gene Xpert MTB/RIF

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Sað Orta Lob Sendromuna Neden Olan Hiler Lenf Nodu Tüberküloz Lenfadeniti: Olgu Sunumu

Shital PATIL¹, Mazhar Mirza^2
1MIMSR Týp Fakültesi, Göðüs Hastalýklarý Anabilim Dalý, Latur, Maharaþtra, Hindistan
²MIMSR Týp Fakültesi, Ýç Hastalýklarý Anabilim Dalý, Latur, Maharaþtra, Hindistan

Orta lob sendromu (OLS) nadir görülen ve sað akciðer orta lobda bazen de sol akciðer lingulada tekrarlayan veya kronik kollaps ile karakterize önemli bir klinik tablodur. Burada, öksürük, ateþ, nefes darlýðý gibi tropikal bir hastalýðýn tipik semptomlarý olan 52 yaþýndaki bir kadýn olgu sunulmaktadýr. Balgam örnekleri yetersiz olduðu için grafideki OLS'yi belirlemek amacýyla bronkoskopik inceleme yapýldý. Transbronþial lenf nodu iðne aspirasyonu ve bronkoalveoler lavaj alýndý. M. tuberculosis, lenf bezinde GeneXpert MTB/RIF assay ile saptandý. Dört haftada azaltýlan dozlarda steroid ile beraber dörtlü antitüberküloz tedavi baþlandý ve 8 ay sürdürüldü. Tam bir klinik ve radyolojik iyileþme görüldü ve bronkoskopik olarak da iyileþme saptandý. OLS için yüksek þüphe duyulan olgularda taný için tüm tetkikler yapýlmalýdýr.

Anahtar Kelimeler: orta lob sendromu, tüberküloz lenfadenit, bronkoskopi, BAL, Gene Xpert MTB/RIF

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