Lung fibrosis and cavitation mimicking tuberculosis

Author:

Davies D

Date: 15 May 2009

Abstract:

During an investigation into the colonization of residual tuberculous cavities withAspergillus species, a group of 67 patients was found in whose sputum tubercle bacilli hadnot been recorded, despite the presence of cavitation. Colonization was much commonerin this group than in those with bacteriologically proven tuberculosis.As a result of a detailed analysis it was considered that about two fifths of these patientshad tuberculous disease. Single examples of cavitating carcinoma and post-pneumoniccavitation were found. Six patients were considered to have bullous emphysema and twoto have allergic bronchopulmonary aspergillosis with aspergilloma.Four patients had ankylosing spondylitis with lung fibrosis and cavitation. Reasons aregiven for believing them to have a particular form of lung disease associated with spondylitis.In five patients aspergillomas were present on the first available radiograph and thenature of the underlying disease could not be determined.Thirteen patients were considered to have ‘idiopathic’ lung fibrosis and in eight this wasprogressive. Attention is drawn to this ill-documented type of disease.The excess of patients with aspergilloma and serum precipitins in the series (incomparison with the larger group in whom tubercle bacilli had been found) was partlyexplained by the inclusion of patients with aspergilloma at first presentation, of patientswith bronchopulmonary aspergillosis and of patients with cavities associated with ankylosingspondylitis, all of which had been colonized.

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