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Hwang, Jung, Lim, Yang, and Im: A Case of Atypical Distribution of Pulmonary Tuberculosis in Bedridden Patient with Quadriplegia
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 69(1): 52-55.

Published online: 31 July 2010

DOI: https://doi.org/10.4046/trd.2010.69.1.52

A Case of Atypical Distribution of Pulmonary Tuberculosis in Bedridden Patient with Quadriplegia

Hun Gyu Hwang, M.D.1, Eun Jung Jung, M.D.1, Gune Il Lim, M.D.1, Seung Boo Yang, M.D.2, Han Hyeok Im, M.D.2

1Respiratory Division, Department of Internal Medicine, Gumi, Korea.

2Department of Radiology, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi, Korea.

Address for correspondence: Hun Gyu Hwang, M.D. Respiratory Division, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, 250, Gongdandong, Gumi 730-706, Korea. Phone: 82-54-468-9040, Fax: 82-54-463-7504, hwangpark@hanmail.net

Received 7 April 2010       Accepted 26 April 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Pulmonary tuberculosis has intermediate prevalence in Korea. It is known that tuberculosis infection predominantly involves the upper lobes, based on the fact that multiplication of Mycobacterium tuberculosis is favored in areas with decreased pulmonary blood flow, impaired lymphatic drainage, and high oxygen tension. We report this case of a 40-year-old man who was brought to our hospital with hemoptysis and dyspnea. Prior to admission, the patient had been in a bedridden state for 15 years due to an injury of the cervical spine 4~5. A 3-Dimensional computed tomography showed predominantly longitudinal distribution of centrilobular nodules along the anterior chest wall, in the left lung. MTB-PCR and AFB culture of bronchial washing fluid revealed pulmonary tuberculosis. This case shows that long-standing supine posture and decreased motion of the anterior chest wall may change the distribution of preferential infection site of Mycobacterium tuberculosis in the lung, resulting in a ventral predominance of tuberculosis infection in the quadriplegic patient.

Keywords: Tuberculosis, Quadriplegia, Tomography, X-Ray Computed

Figures and Tables

Figure 1
Chest X-ray shows (A) peribronchial patchy infiltration in left upper and lower lung fields on admission, and (B) much cleared lung field after antituberculosis treatment for 9 months.
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Figure 2
Sagittal section of lung setting shows (A) patchy and centrilobular infiltration prominently in anterior chest wall of left lung field, and (B) much cleared lung field after antituberculosis treatment for 9 months.
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Figure 3
Coronal section of lung setting shows (A) patchy and centrilobular infiltration in line along anterior chest wall of left lung field, and (B) much cleared lung field after antituberculosis treatment for 9 months.
trd-69-52-g003

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