Pulmonary tuberculosis complicating asbestosis

YF Shea, Janice JK Ip
2014 Hong Kong Medical Journal  
An 87-year-old man who previously worked in shipyard with asbestosis was admitted in November 2012 because of fever of unknown origin. He presented with fever on-and-off for 2 months and cough. On physical examination, there was no cervical lymphadenopathy or hepatosplenomegaly and the chest was clear. Complete blood picture, and liver and renal function tests remained unremarkable. Chest X-ray (CXR) and computed tomography (CT) of the thorax yielded calcified pleural plaques, diaphragmatic
more » ... , diaphragmatic calcification, diffuse centrilobular nodules, and interstitial septal thickening (Fig 1) . Sputum and urine cultures were negative. Further investigations included smears and cultures for acid-fast bacilli and testing for Mycobacterium tuberculosis (MTB) by polymerase chain reaction of sputum, urine, and bronchoalveolar larvage samples, all of which were negative. Searches for aspergillus antigen, cryptococcal antigen, the Weil-Felix test, the Widal test, nasopharyngeal aspirate for influenza and mycoplasma, urine examination for legionella antigen, automminue profiling, and tests for tumour markers, human immunodeficiency virus, and sputum cytology were all non-contributory. The patient's C-reactive protein was elevated to 3.39 mg/dL (reference range, <0.76 mg/dL). His fever had persisted on-and-off for 2 months despite multiple courses of broad-1 YF Shea *, MRCP (UK), FHKAM (Medicine)
doi:10.12809/hkmj134019 pmid:24914084 fatcat:fevajmm6abc65pw3ntnkmct4fy