Chronic febrile respiratory illness with acino-nodular consolidations as presenting feature of granulomatosis with polyangiitis: A case report with review of literature

Patil, Shital; Gondhali, Gajanan; Deepak, Parakkal

doi:10.4103/japt.japt_24_22

Cited by 3 publications

(2 citation statements)

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“…Final outcome in delayed treatment initiation may lead to destroyed lung as post tuberculosis sequel and proportionate number of cases may have lung function abnormalities irrespective of radiological outcome [18][19][20]. Tuberculosis may be misdiagnosed due to confusing or overlapping clinical and radiological features in high burden setting like India [21][22][23][24]. In present case report we have reported advanced pulmonary tuberculosis with delayed diagnosis due to lack of awareness in patient, accompanying relatives and care takers and family physicians to symptoms, available diagnostic modalities and universally acceptable and freely available treatment options for tuberculosis as per NTEP program in India.…”

Section: Introductionmentioning

confidence: 99%

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Patil¹,

Gondhali²,

Choudhari³

et al. 2023

SAR J Med

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Tuberculosis is a more prevalent disease and the leading cause of death from an infectious agent in India. Tuberculosis in India accounts for the highest number of cases and deaths annually in the world. In spite of an efficient National tuberculosis control program for five decades, Tuberculosis is still the number one cause of death due to infectious agents in India and one third of total global deaths occurs in India due to this disease. Burden of drug sensitive and drug resistant cases is highest in the south east Asian region with maximum cases in India and China. India has launched a National strategic plan to end TB in 2017 with a target to eliminate TB by 2025. Main theme of the national strategic plan is ‘TB Free India’ with the vision of zero TB disease, zero deaths due to TB and decreasing poverty due to TB. Tuberculosis is an ancient disease and history traced before the evolution of mankind on this planet. Tuberculosis primarily affects the lung and is classified pathologically as primary, post-primary and progressive primary tuberculosis. In this case report, a 62-year male, presented with constitutional symptoms for six-month duration with partial response to medical treatment. He was having low grade fever, cough, shortness of breath, weight loss and anorexia for 6 months. His symptoms were progressive and empirically treated as enteric or typhoid fever for four to five occasions with oral and intravenous antibiotics with steroids with general physicians and family physicians. Additionally, he received empirical treatment as jaundice, viral fever, bronchitis, asthma, and generalised debilitating disease. Relatives brought to our center worsened general health with increased shortness of breath. Clinically he was having bilateral crepitations with decreased breath sounds right lower axillary and infrascapular area. Chest x-ray showed right pleural effusion with miliary opacities bilateral lung field. HRCT thorax showed typical miliary opacities with conglomerated pattern and pleural effusion on the right side of thorax. Pleural fluid analysis revealed exudative effusion with raised ADA level. He was unable to produce sputum, we have done bronchoscopy and BAL evaluation confirmed pulmonary tuberculosis and sensitivity pattern. BAL cytology documented acid-fast bacilli in smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT). We have recorded near complete radiological resolution, bacteriological cure after eight months of ATT with good compliance. More awareness is required regarding symptoms, diagnosis and treatment of tuberculosis to family physicians and general practitioners as the majority of the rural population receives treatment from these health professionals.

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Section: Introductionmentioning

confidence: 99%

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Patil¹,

Gondhali²,

Choudhari³

et al. 2023

SAR J Med

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“…During COVID-19 pandemic antigenic cross reactivity has documented with dengue fever [10][11][12][13]. Similarly, deregulated immune phenomenon has been documented after covid vaccination and transient autoimmune features have been reported in various studies [14][15]. COVID-19 related extrapulmonary manifestations have been reported secondary to dysregulated immune response and systemic effects on immunity & immunosuppression resulting into tuberculosis [16], central nervous system resulting into stroke [17] and endocrinal effects resulting into hyponatremia [18].…”

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confidence: 99%

Hydroxychloroquine as ‘Potential Treatment Option’ for Persistent Immune Dysregulation in Long COVID: Revisiting Its New Use as a ‘Versatile’ Molecule!

Patil,

Gondhali

2023

SAR J Med

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COVID-19 pandemic is over now and we are in great peace of relief after three years of first case reported in China. This pandemic has observed a significant impact on quality of life globally and this puts unforgettable imprints on the history of mankind. Reason for more havoc in this pandemic was less studied virus before this ‘unpredicted or surprise pandemic’ by medical scientists regarding its pathophysiology, available treatment options and lack of effective vaccine to tackle this dragon. Rationale would be COVID-19 is the first observed and reported pandemic of corona virus related global disease apart from its previously occurring SARS and MERS Epidemics. Fast track developments in medical treatment options with use of ultrafast digital and artificial intelligence techniques have curtailed mortality on a large scale globally. Although mortality is significantly reduced, morbidity is documented in significant number of cases worldwide after this Dragon related pandemic. Morbidity due to COVID-19 now called as ‘Long COVID’, which is underreported & half-heartedly evaluated globally. Long COVID is related to persistent immune dysregulation which occurred during evolution of COVID-19 as a natural trend of disease & documented during the course of active viremia, during recovery of viral illness and after the post viral phase. Immune dysregulation occurs in a ‘selected group’ of cases irrespective of disease severity and vaccination status, and observed in cases irrespective of severity of illness as with negligible illness resulted into brainstorming effect on medical scientists and researchers as of today to advanced and mandates further global research. Globally, one third of recovered or affected cases of COVID-19 are facing long covid and need prompt treatment options to tackle this dragon related long term effect on body. ‘Immunomodulatory’ or immunity modifying agents are the primary targets to curtail immune dysregulation and long covid. Some experts recommend ‘disease modifying agents’ to treat long covid cases. Still, many miles to go to reach effective treatment options for long covid and we don’t have effective options as of now for this ‘health issue of global concern’ related to Dragon. Hydroxychloroquine is initially used as an antimalarial and as an anti-inflammatory molecule for decades in various rheumatic conditions with satisfactory results. Despite decades of dependable use and predictable results in the treatment of rheumatic disease, HCQ remains a drug with an ever-expanding number of underlying mechanisms. HCQ was tried initially for prophylaxis treatment of COVID-19 due to its anti-inflammatory properties but has not shown any dramatic results. WHO has removed HCQ from the treatment plan after many trial results with disappointing outcomes. HCQ is a drug with multiple beneficial pleiotropic effects such as immunomodulatory effects which regulates immunological responses that inhibit dysregulated immune system. These Immunomodulatory and or diseases modifying effects of HCQ makes it the future candidate with ‘game changer’ role for management of Long covid resulting from immune dysregulation as a core pathophysiologic pathway of this Dragon Pandemic. Revisiting this old drug with ‘versatile effects’ can be used as treatment option for short time as frontline molecule for Long covid when no definitive options are available after consideration of risk benefit ratio which is a cost-effective treatment option.

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Granulomatosis with polyangiitis masquerading as disseminated tuberculosis in presence of bilateral lung cavities and hemorrhagic infarct

Patil,

Tak

2024

SRJHS

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Lung cavitations with constitutional symptoms are usually associated with pulmonary tuberculosis due to its high prevalence and are the most common infectious cause in India. Granulomatosis with polyangiitis (GPA) with the systemic pulmonary disease will have different radiological presentations such as nodule, mass, and consolidation with or without cavitation. In this case report, we have reported a 40-year-old female presented with cough, fever, and weight loss of 6 months duration with chest imaging suggestive of bilateral cavitary lung disease. She was labeled as a case of disseminated tuberculosis due to involvement of the central nervous system and empirically treated with anti-tuberculosis treatment (ATT) without microbiological evidence of tuberculosis in smear and cartridge-based nucleic acid amplification tests. The absence of clinical response and radiological worsening to empirical ATT gives a clue for an alternate diagnosis. Bronchoscopy workup documented Aspergillus colonization and vasculitis workup in the presence of cavitary lung disease documented abnormally raised proteinase 3 anti-neutrophil cytoplasmic antibodies titers. She was treated with a combination of systemic methylprednisolone and azathioprine with voriconazole. Her clinical response was observed in 4 weeks and radiological response with complete radiological clearance of pulmonary cavitations was documented after 6 months of treatment. We recommend prompt workup and ruling out GPA in all cases with pulmonary cavitations with negative microbiological workup and no empirical ATT should be given in the era of rapid microbiological tests with good sensitivity and specificity.

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Chronic febrile respiratory illness with acino-nodular consolidations as presenting feature of granulomatosis with polyangiitis: A case report with review of literature

Cited by 3 publications

References 0 publications

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Hydroxychloroquine as ‘Potential Treatment Option’ for Persistent Immune Dysregulation in Long COVID: Revisiting Its New Use as a ‘Versatile’ Molecule!

Granulomatosis with polyangiitis masquerading as disseminated tuberculosis in presence of bilateral lung cavities and hemorrhagic infarct

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