The patient was a 48-year-old male, smoker (30 pack-years), but not yet seriously ill. The patient was vaccinated against TB as a child. He is married and resides in an apartment with his family. The patient arrived at the hospital complaining of sudden hemoptysis. He reported that he had been coughing more than usual during the last month and had been short of breath upon exertion. He was afebrile and had lost 20 kg over the course of 9 months. A posteroanterior chest X-ray showed diffuse bilateral infiltrates (Fig. 1). A sputum examination repeatedly demonstrated massive smear positivity and a finding of acid-fast bacilli, which was followed by culture positivity 3 weeks later. A Bactec MGIT 960 examination produced a positive result on the 8th day and PCR tests results were also positive. The Mantoux TST showed an induration of +15 mm. Typing demonstrated Mycobacterium tuberculosis complex (MTB) with preserved sensitivity to first-line antituberculous medications. HIV test results were negative. First-line antituberculosis treatment (AT) was started immediately with a combination of rifampicin, isoniazid, ethambutol and pyrazinamide. After 2 months, sputum samples were both culture-negative and smear-negative for MTB. Given the extent of the disease, the initial phase of AT treatment was extended to 3 months, with a follow-on phase of bi-therapy with rifampicin and isoniazid for 6 months. Treatment was effective with no adverse effects. Radiograph findings gradually regressed and the patient's clinical condition improved significantly (Fig. 2).
The patient's wife was examined during the course of a TB contact investigation.