Respiratory Medicine Case Reports 13 (2014) 12
Contents lists available at ScienceDirect
Respiratory Medicine Case Reports journal homepage: www.elsevier.com/locate/rmcr
Case report
Complication of antiquated tuberculosis treatment Bryan Husta*, Sunjay Devarajan, Cristina A. Reichner Georgetown University Hospital, United States
a b s t r a c t Keywords: Tuberculosis Plombage Oleothorax Staphylococcus lugdunensis
In the early 20th century, the rapid spread of tuberculosis (TB) invited novel therapies for treatment. A surgical procedure known as plombage was one such method where lobes were forced to collapse by placing an inert object such as mineral oil, paraffin wax, gauze or Lucite (methyl methacylate) balls. The collapse would lead to isolation of TB infection and decrease aeration of the affected lung. Removal of these objects had initially been, usually after 24 months, however this fell out of favor after the patient had recovered without commonly seen late complications. Decades later, reports have been made illustrating complications such as migration and infection of the plombe as well as expanding oleothorax. © 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
We describe the case of a 79 year old African American female who presented with a 4 month history of progressive shortness of breath. She had previously been treated for TB with right pneumonectomy and plombage treatment using paraffin and mineral oil. Physical exam findings revealed decreased breath sounds in the right lung with dullness to percussion in the absence of wheezing and her left lung was clear to auscultation. A roentgenogram demonstrated a right pleural effusion increased from her previous images. Initial drainage was performed with temporary relief of symptoms revealing 1.3 L of yellowebrown thick oily fluid without evidence of infection or malignancy. Two months afterward, symptoms recurred with similar exam and image findings. She developed weight loss and chills without fevers. Right pleural fluid was evaluated and a chest tube was placed after thick purulent yellow material was aspirated. Cultures grew Enterococcus faecalis, Pseudomonas aeruginosa, and Staphylococcus lugdunensis and she was treated with intravenous antibiotics and transitioned to oral linezolid and levofloxacin. Chest tube was kept in place given continued output of clear, oily yellow fluid. Three weeks after discharge chest tube was removed however shortness of breath returned. She continued to have drainage from the site of the chest tube with yellowebrown oily material soaking through 2e3 occlusive dressings daily and associated 10 lb weight loss. She was found to have extravasation of the plombe material through the chest wall on further imaging and continued
Fig. 1. Explanted plombage material.
oleothorax. She was managed with multiple surgical washouts and debridement procedures before improving and undergoing chest closure (Fig. 1). This unusual case highlights the need to be aware of antiquated therapies in treatment of TB as late complications may occur.
* Corresponding author. Georgetown University Hospital, Pulmonary and Critical Care, 3800 Reservoir Road NW, M4200 Washington, DC 20007, United States. Tel.: þ1 2023047862; fax: þ1 2024440032. E-mail addresses: [email protected], [email protected] (B. Husta). http://dx.doi.org/10.1016/j.rmcr.2014.07.001 2213-0071/© 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
Contents lists available at ScienceDirect
Respiratory Medicine Case Reports journal homepage: www.elsevier.com/locate/rmcr
Case report
Complication of antiquated tuberculosis treatment Bryan Husta*, Sunjay Devarajan, Cristina A. Reichner Georgetown University Hospital, United States
a b s t r a c t Keywords: Tuberculosis Plombage Oleothorax Staphylococcus lugdunensis
In the early 20th century, the rapid spread of tuberculosis (TB) invited novel therapies for treatment. A surgical procedure known as plombage was one such method where lobes were forced to collapse by placing an inert object such as mineral oil, paraffin wax, gauze or Lucite (methyl methacylate) balls. The collapse would lead to isolation of TB infection and decrease aeration of the affected lung. Removal of these objects had initially been, usually after 24 months, however this fell out of favor after the patient had recovered without commonly seen late complications. Decades later, reports have been made illustrating complications such as migration and infection of the plombe as well as expanding oleothorax. © 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
We describe the case of a 79 year old African American female who presented with a 4 month history of progressive shortness of breath. She had previously been treated for TB with right pneumonectomy and plombage treatment using paraffin and mineral oil. Physical exam findings revealed decreased breath sounds in the right lung with dullness to percussion in the absence of wheezing and her left lung was clear to auscultation. A roentgenogram demonstrated a right pleural effusion increased from her previous images. Initial drainage was performed with temporary relief of symptoms revealing 1.3 L of yellowebrown thick oily fluid without evidence of infection or malignancy. Two months afterward, symptoms recurred with similar exam and image findings. She developed weight loss and chills without fevers. Right pleural fluid was evaluated and a chest tube was placed after thick purulent yellow material was aspirated. Cultures grew Enterococcus faecalis, Pseudomonas aeruginosa, and Staphylococcus lugdunensis and she was treated with intravenous antibiotics and transitioned to oral linezolid and levofloxacin. Chest tube was kept in place given continued output of clear, oily yellow fluid. Three weeks after discharge chest tube was removed however shortness of breath returned. She continued to have drainage from the site of the chest tube with yellowebrown oily material soaking through 2e3 occlusive dressings daily and associated 10 lb weight loss. She was found to have extravasation of the plombe material through the chest wall on further imaging and continued
Fig. 1. Explanted plombage material.
oleothorax. She was managed with multiple surgical washouts and debridement procedures before improving and undergoing chest closure (Fig. 1). This unusual case highlights the need to be aware of antiquated therapies in treatment of TB as late complications may occur.
* Corresponding author. Georgetown University Hospital, Pulmonary and Critical Care, 3800 Reservoir Road NW, M4200 Washington, DC 20007, United States. Tel.: þ1 2023047862; fax: þ1 2024440032. E-mail addresses: [email protected], [email protected] (B. Husta). http://dx.doi.org/10.1016/j.rmcr.2014.07.001 2213-0071/© 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
