TB - Tuberculosis Hodge-podge

Yesterday we saw an interesting case at the end of the day of a patient on immunosuppression who presented with a new left sided pleural effusion and some parenchymal changes compatible with a flare of her underlying lung disease vs. tuberculosis.

This patient comes from an endemic country and has evidence of fibronodular changes on chest x-ray (RR for reactivation ~15). There has been no previous TB treatment.

This highlights a large number of good teaching points:

1. Diagnosis and management of latent TB.
2. Diagnostic approach to possible TB pleuritis.
3. The interplay between TB and TNF-alpha inhibitors.
4. The radiographic manifestations of TB and the differences in immunosuppressed hosts.
5. The yield of bronchoscopy in patients who are not coughing.
6. The potential role for gastric aspirate to make the diagnosis

FYI - Canadian Tuberculosis Standards (Guidelines) available for free here.