Background: Diabetes and Tuberculosis are known to be mutually affective. In high tuberculosis and Diabetes burden country like ours, it is essential that we understand all the aspects concerning both these diseases individually and in mutual coexistence, in order to improve the management of this unhealthy partnership.Methods: This is a prospective hospital based observational study, in which 100 patients with coexisting Diabetes and new sputum confirmed pulmonary tuberculosis with no other comorbidities were included. Detailed history, examination and appropriate investigations were done evaluating the clinical and radiological presentation and treatment response in terms of sputum conversion at follow up visits.Results: Predominant symptoms were anorexia, fever and cough with sputum, majority with duration of more than 4 weeks. About half of them had diabetes duration of less than 1 year, most being newly diagnosed. All cases had upper lobe involvement; two thirds of them had lower lung field and multiple lobe involvement. Confluent consolidation, cavitary lesions and fluffy infiltrates were common. 27 of the 100 cases had a delayed sputum conversion. Longer duration of diabetes, maintenance on oral hypoglycaemic drugs alone and uncontrolled diabetes had delayed sputum conversion.Conclusions: Presenting symptoms of tuberculosis in diabetics is more or less similar to that in non-diabetics. Atypical radiological presentation with lower lung field involvement and confluent consolidation mimicking pneumonia is common. Delay in sputum conversion is common in dual disease and is increased with increasing DM duration and poor glycemic control. Better results may be obtained with insulin therapy.
Pulmonary mucormycosis is rare life‐threatening infection affecting mostly immunocompromised individuals such as diabetes mellitus, hematological malignancies, chronic renal failure, post transplantation etc. Based on the anatomic site involved, mucormycosis can be one of several forms, such as rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and uncommon presentations that include endocarditis, osteomyelitis, peritonitis, and renal infection. Pulmonary infection is the most common form of mucormycosis recognized in patients with hematological malignancy and remains the second most common presentation after rhinocerebral infection in diabetic patients. Its presentation in the lungs may mimic cavitary diseases like tuberculosis, mass lesions as in malignancies and non-resolving pneumonias. Here we report a case of isolated pulmonary mucormycosis in an uncontrolled diabetic male patient with a cavitary lesion. Diagnosis was made with a bronchoscopic biopsy and treatment was completely medical with liposomal amphotericin B.
Pseudoneurysms of the subclavian artery after blunting thoracic trauma presenting with a complication of hemoptysis are rare, most of which occur early, within days of trauma and represent a challenging surgical problem. Only a few scattered case reports are found in the literature. Here, we present the case of a 36-year-old male, with a history of blunt injury to the chest with right clavicular fracture, a few years back, who presented with cough, hemoptysis and shortness of breath of five days duration. On complete evaluation it was found that these complaints were due to a sub clavian artery pseudo aneurysm in the proximal part, which is compressing on the right upper lobe bronchus and blood leaking into the parenchyma and airways producing the symptoms. He was managed conservatively and stabilized. Later aneurysm resection and anastomosis was done electively. The patient is now asymptomatic and healthy.
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