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

Hwang, Hun Gyu; Jung, Eun Jung; Lim, Gune Il; Yang, Seung Boo; Im, Han Hyeok

doi:2010.69.1.52

Tuberc Respir Dis > Volume 69(1); 2010 > Article

Case Report

Tuberculosis and Respiratory Diseases 2010;69(1):52-55.
DOI: https://doi.org/10.4046/trd.2010.69.1.52 Published online July 1, 2010.

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

Hun Gyu Hwang, Eun Jung Jung, Gune Il Lim, Seung Boo Yang, Han Hyeok Im

¹Respiratory Division, Department of Internal Medicine, Gumi, Korea. hwangpark@hanmail.net
²Department of Radiology, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi, Korea.

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.

Key Words: Tuberculosis, Quadriplegia, Tomography, X-Ray Computed