The complexities of complex treatment of a patient with widespread destructive pulmonary tuberculosis against the background of severe pulmonary bullous dystrophy after exogenous exposure to fine particles of coal dust in the anamnesis

Abstract

An observation from practice is given – a staged surgical treatment of a patient with widespread destructive pulmonary tuberculosis with preXDR MBT against the background of severe bullous lung dystrophy after prolonged exogenous exposure to fine particles of coal dust in the anamnesis. Patient M., 42 years old, smoker, has been working as a loader at a railway station since the age of 20, unloading wagons with bags of coal at high temperatures without using personal protective equipment. He was ill with pulmonary tuberculosis 12 years ago, the original form: infiltrative tuberculosis of the upper lobe of the right lung in the phase of decay and insemination. He was treated with positive dynamics, was removed from the register 10 years ago, the real changes were revealed during a routine examination when applying for a vertebral hernia. According to computed tomography of the chest organs, a picture of fibrous-cavernous tuberculosis of the right lung with a system of polymorphic caverns with multiple foci of dropout in the left lung against the background of pronounced emphysema of both lungs was noted upon admission. He was admitted to the clinic with complaints of shortness of breath at rest (mMRC 3). The patient was selected therapy based on sensitivity data and individual intolerance. The patient underwent EC installation at the mouth of the upper lobe bronchus on the right, successfully, then at the mouth of the bronchus B6, the blocker was coughed up. Against the background of treatment, tuberculomas formed in the left lung. S1-2 resection of the left lung was performed. The patient suffered SARS CoV-2. After that, spontaneous pneumothorax occurred on the left, and therefore the pleural cavity was drained. Against the background of the lack of dynamics, a month after drainage, the patient was taken for revision of the left pleural cavity with suturing of defects, partial pleurectomy and decortication of the left lung. After 3 months, the patient had a bronchoblocker removed from the mouth of the ULB on the right and a combined resection of the right lung (upper lobectomy with S6) was performed, after which, in order to reduce the right hemithorax and reduce the overstretch of the right lung, thoracoplasty was performed with resection of the I-IV ribs on the right. Histological examination confirmed pulmonary tuberculosis against the background of exogenous exposure to fine particles of coal dust (by the type of hypersensitive pneumonitis of chronic course). As a result of treatment, the patient's symptoms of shortness of breath (mMRC 1) decreased, the patient was steadfastly abaculated and returned to a normal lifestyle.