| Abstract [eng] |
Objective: to review the literature on the epidemiology, diagnostic challenges, treatment options and clinical presentation of pulmonary tuberculosis and chronic hypersensitivity pneumonitis. Methods: a review of the scientific literature was performed, assessing recent studies on pulmonary tuberculosis and chronic hypersensitivity pneumonitis using PubMed, ClinicalKey, Google Scholar databases. A total of 41 publications were selected and included in the review. A clinical case illustrating the diagnostic challenges and the course of treatment is also presented. Case report: a 74-year-old female patient complaining of chronic cough and dyspnoea underwent extensive radiological and laboratory investigations. At the onset of the disease, bronchoalveolar lavage test showed no acid-fast bacilli, but Xpert MTB/RIF confirmed Mycobacterium tuberculosis infection without rifampicin resistance. After starting specific anti-tuberculosis treatment, the symptoms partially regressed but the radiological changes persisted. Further investigations suggested chronic hypersensitivity pneumonitis, and the patient's management was adjusted to include anti-inflammatory treatment with glucocorticoids. Conclusions. certain radiological features may help to differentiate chronic hypersensitivity pneumonitis from tuberculosis, but these methods alone are not sufficient, as a thorough clinical, laboratory and histological evaluation is required. For tuberculosis, the identification of the tuberculosis mycobacterial complex by molecular methods or culture remains the main diagnostic standard, whereas chronic hypersensitivity pneumonitis is diagnosed on the basis of a known causative antigen, an increase lymphocyte infiltration in the bronchoalveolar lavage fluid, and characteristic radiological and histopathological features. Treatment depends on the diagnosis, with pulmonary tuberculosis being treated with a standard four-drug regimen, while in chronic hypersensitivity pneumonitis the mainstay of treatment is to discontinue contact with the antigen and, if necessary, treatment with glucocorticoids or antifibrotic drugs. |
