Pulmonary tuberculosis related diffuse cystic lung disease with recurrent pneumothorax mimicking pulmonary lymphangioleomyomatosis in Ethiopia: A review and case report

Millions of individuals worldwide are afflicted by the fatal infectious disease tuberculosis, which accounts for thousands of avoidable deaths. The literature has provided a good description of the clinical manifestation and radiologic features of pulmonary tuberculosis. However, the parenchymal complication of pulmonary tuberculosis presenting as cystic lung disease, has not been widely documented in the literature and is one of the incredibly uncommon causes of diffuse cystic lung disease. It is very uncommon to have a patient with possible pulmonary lymphangioleomyomatosis to be superinfected with bacteriologically confirmed tuberculosis.

This report describes a young female patient who was admitted to the hospital, had repeated chest tube insertions and drainage of recurrent spontaneous pneumothoraxes secondary to likely diffuse cystic lung disease related to pulmonary tuberculosis. First, it was thought that the most likely diagnosis was pulmonary lymphangioleomyomatosis. The patient ultimately diagnosed with diffuse cystic lung disease associated with pulmonary tuberculosis as the most likely cause of her clinical presentation considering the high index of suspicion and her sputum gene xpert results. For drug-susceptible tuberculosis, the patient was finally started on anti-tuberculosis medication. She had both clinical and radiological improvement after completion of her anti tuberculosis treatment.

Thus, it is reasonable to conclude that tuberculosis may contribute to diffuse cystic lung disease (DCLD) in tuberculosis endemic settings such as Ethiopia, and that appropriate diagnostic efforts should be undertaken to make the diagnosis. A high index of clinical suspicion is crucial to prevent delays in the diagnosis of diffuse cystic lung disease associated with pulmonary tuberculosis.