A 35-year-old female was admitted to a community hospital because of polypnea, cough, sputum and intermittent fever four months ago. She has a medical history of HBV infection. The patient denied a history of smoking. Local CT scans revealed right pleural effusion and pleural thickening. Diagnostic thoracentesis showed tuberculous exudative fluid. A diagnosis of tuberculous pleuritis was speculated. The patient started anti-tuberculosis therapy with isoniazid, rifampicin, ethambutol and pyrazinamide. The patient's symptoms were gradually relieved, and the therapy was continued. Two weeks before, the patient developed cough and sputum. CT scans revealed a 3.9cm x 2.9cm mass in the right middle and inferior pulmonary lobe with no pleural effusion (Figure 4). WBC was 7.03x109/L with 80.90% neutrophils. HGB was 122g/L. Results of examinations of ESR, CRP, liver function, tumor markers, GM-test, G-test and autoantibodies related to connective tissue disease were normal. HIV test was negative. IGRAs and tuberculin skin test were positive. Sputum smears and culture were negative for acid-fast bacilli. CT-guided percutaneous lung biopsy showed plentiful infiltration of epithelioid cells and lymphocytes (Figure 5). The patient was diagnosed as PR paradoxical and was continued on the original anti-tuberculosis therapy. She recovered well during the follow-up. Local CT scans showed that the pulmonary mass was diminished three months later.
Case 2. CT findings in the right middle and inferior pulmonary lobe. (A and B) A 3.9cmx2.9cm lobulated mass without pleural effusion was found was after four months of anti-tuberculosis treatment.