Comprehensive treatment using surgical methods in a teenage patient with advanced fibrotic-cavernous pulmonary tuberculosis. Case report
Year: 2026
Type: article
Study design: Case Report
Abstract: According to the World Health Organization, approximately 12% of all diagnosed tuberculosis cases occur in children under 14 years of age. Notably, children account for 15% of the total deaths attributed to tuberculosis. The increasing drug resistance observed in Mycobacterium tuberculosis, combined with the limited effectiveness of non-surgical treatment options for complicated and drug-resistant tuberculosis, as well as the lower incidence of surgical interventions in pediatric and adolescent populations, highlights the pressing need to reevaluate management strategies for this demographic. Despite the significance of this issue, the literature addressing surgical interventions in pediatric patients remains scarce. This report presents a case of comprehensive treatment for a 17-year-old patient diagnosed with advanced fibrous-cavernous pulmonary tuberculosis The patient E. has been under the care of a tuberculosis specialist since 2018, following close contact with his infected mother. He began to exhibit symptoms in July 2020, including dyspnea and episodes of hyperthermia. Subsequent examinations on September 24, 2020, revealed pulmonary abnormalities, prompting treatment for 6 months. Upon further assessment, the patient was found to have developed resistance to isoniazid, rifampicin, and fluoroquinolones, requiring an adjustment to his therapeutic regimen. Throughout the treatment course, the patient experienced hemoptysis, with blood loss reaching approximately 10 mL per day; this complication was effectively resolved through hemostatic therapy. Computed tomography scans identified multiple lung cavities of varying sizes, the largest measuring 29×25×38 mm. A thorough fibrobronchoscopy did not identify the source of the hemoptysis. To address the recurrent hemoptysis in accordance with the radiological findings, a staged surgical intervention was undertaken. The first stage involved a combined resection of the left lung, consisting of upper lobectomy and partial resection of the S6 segment. An artificial pneumoperitoneum of 1000–1200 mL was used weekly for three months to facilitate cavity compression and induce a collapsogenic effect. Following a five-month interval, the patient underwent a second surgical procedure, which entailed a combined resection of the right lung, consisting of upper lobectomy and the precise excision of the S4 lesion. The treatment lasted 14 months, from the presentation to the end of therapy. The optimal outcome in this adolescent patient was achieved through a multifaceted approach that included staged surgical interventions, tailored individualized therapies during both pre- and postoperative periods, and the implementation of a collapsotherapy.
Source: Consilium Medicum
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7220459115