Waxing and Waning Pulmonary Nodules and Myelodysplastic Syndrome
Waxing and Waning Pulmonary Nodules and Myelodysplastic Syndrome
A 53-year-old diabetic woman with the diagnosis of myelodysplastic syndrome was admitted to our hospital with symptoms of anorexia, malaise, fatigue, night sweats, and weight loss. The radiological evaluation revealed waxing and waning pulmonary nodules. A diagnosis of pulmonary tuberculosis was reached by pathologic examination of a wedge biopsy. We did not find a similar case in the literature. Clinicians should keep tuberculosis in mind as a possible etiology of waxing and waning pulmonary nodules.
Tuberculosis is a granulomatous disease of infectious origin caused by Mycobacterium tuberculosis. The lung is the major portal of entry and the most affected organ, though any organ of the body may be affected by hematogenous or lymphatic spread. Primary infection is usually silent and unrecognized; in those in whom active disease develops, either from progression of primary infection or endogenous reactivation, it can manifest itself in many ways, depending on the site of involvement and a variety of host factors. Diabetes mellitus, malnutrition, immunosuppressive therapy, and HIV infection are the most common factors known to decrease the body's immunity and facilitate the onset of tuberculous disease. Atypical clinical presentations are most commonly seen in immunosuppressed patients.
We report a diabetic patient with myelodysplastic syndrome who developed an atypical manifestation of pulmonary tuberculosis: waxing and waning pulmonary nodules. To our knowledge, this is the first pulmonary tuberculosis case presenting in such a fashion.
Abstract and Introduction
Abstract
A 53-year-old diabetic woman with the diagnosis of myelodysplastic syndrome was admitted to our hospital with symptoms of anorexia, malaise, fatigue, night sweats, and weight loss. The radiological evaluation revealed waxing and waning pulmonary nodules. A diagnosis of pulmonary tuberculosis was reached by pathologic examination of a wedge biopsy. We did not find a similar case in the literature. Clinicians should keep tuberculosis in mind as a possible etiology of waxing and waning pulmonary nodules.
Introduction
Tuberculosis is a granulomatous disease of infectious origin caused by Mycobacterium tuberculosis. The lung is the major portal of entry and the most affected organ, though any organ of the body may be affected by hematogenous or lymphatic spread. Primary infection is usually silent and unrecognized; in those in whom active disease develops, either from progression of primary infection or endogenous reactivation, it can manifest itself in many ways, depending on the site of involvement and a variety of host factors. Diabetes mellitus, malnutrition, immunosuppressive therapy, and HIV infection are the most common factors known to decrease the body's immunity and facilitate the onset of tuberculous disease. Atypical clinical presentations are most commonly seen in immunosuppressed patients.
We report a diabetic patient with myelodysplastic syndrome who developed an atypical manifestation of pulmonary tuberculosis: waxing and waning pulmonary nodules. To our knowledge, this is the first pulmonary tuberculosis case presenting in such a fashion.