AB049. Complete atelectasis of the left lung from endobronchial tuberculosis: case presentation in a refugee hotspot

Abstract: Tuberculosis has not been eradicated despite the huge effort of the medical community, due to immigration and AIDS. The large amount of immigrants in Greece and their subsequent residency in specific reception centers (Hotspots) require thorough evaluation of their symptoms in order to prohibit highly contagious diseases like tuberculosis. A 28-year-old female refugee from Afghanistan, with a free medical history, came in Greece and stayed in Samos. Due to a steadily worsening dyspnea for 2 months and cough with purulent sputum antibiotics/inhaled bronchodilators were prescribed. An X-ray revealed a mild enlargement of the left hilum. The patient was transferred and admitted to our department due to respiratory failure and fever. The CXR revealed a large opacity of the left lung and CT complete atelectasis of the LUL and LLL with presence of semiliquid secretions in the left main bronchus. There was leukocytosis (polymorphonuclear). Ampicillin/sulbactam, azithromycin and bronchodilators were firstly prescribed. Blood samples cultured no microorganism, tests for viral hepatitis and HIV were negative. The bronchoscopy revealed white, soft plaques in the mucosa of the trachea and the left main bronchus. The endobronchial biopsies were negative for malignancy and the cultures from bronchial secretions were negative for bacterial microorganisms and mycobacterium. The molecular test (PCR) in bronchial secretions detected M. tuberculosis complex. The antibiotics were discontinued and an anti-TB treatment was set (HREZ). Due to the detection of isoniazid resistance, moxifloxacin and amikacin were added to the treatment. The patient was transferred to MDR-TB Unit and discharged 2 months later with a marked improvement. She went to Germany with instructions for treatment continuation. Tuberculosis can imitate any disease. High suspicion and prompt diagnosis are required in order not only to cure but also to eliminate the spread of this highly contagious and fatal disease. A national TB programme must be implemented effectively to refugee and displaced population.

Keywords: Pulmonary tuberculosis; atelectasis; MDR-tuberculosis