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→Clinical Summary
== Clinical Summary ==
Two months prior to admission, this 57-year-old white male underwent a routine physical examination. During the course of the examination, a lesion was found in the upper lobe of the right lung. Initially, the patient was treated for two weeks with ampicillin. He was then admitted to the hospital for further study. All studies including sputum studies for tubercle bacilli, bronchial washings, and bronchoscopy were negative and he was discharged.
Upon re-admission, a review of systems revealed the presence of mild dyspnea on exertion, accompanied by a slightly productive cough. Of interest was the fact that the patient had had a positive PPD test for the past 4 to 5 years, but this had never been evaluated. At this time, physical and laboratory examinations were unremarkable. Radiographic examination of the chest revealed a 2 x 2-cm density in the right lower lung field. A CT scan revealed several small cavities in this area. The patient underwent a thoracotomy, at which time a portion of the upper lobe of the right lung was removed. Examination of the cut surface revealed small white nodules measuring up to 0.2 cm in diameter.
== Images ==
<gallery heights="250px" widths="250px">
File:IPLab3Tuberculosis5.jpg|This high-power photomicrograph of a tuberculosis granuloma demonstrates acid-fast bacilli (arrows).
</gallery>
== Virtual Microscopy ==
=== Lung: Tuberculosis H&E ===
<peir-vm>IPLab3Tuberculosis_HE</peir-vm>
=== Lung: Tuberculosis AFGT ===
<peir-vm>IPLab3Tuberculosis_AFGT</peir-vm>
=== Normal Lung ===
<peir-vm>UAB-Histology-00107</peir-vm>
== Study Questions ==
* <spoiler text="Does everyone with a positive PPD test have TB?">No, it just indicates exposure to a ''Mycobacterium'' species, many of which are non-pathogenic in humans. Those who have received Bacillus Calmette–Guérin (BCG) vaccination, for instance, routinely have a positive PPD test even though they have never been exposed to ''Mycobacterium tuberculosis''.</spoiler>
* <spoiler text="How does this lesion differ from the lesions seen in sarcoid?">These are caseating granulomas with a central region of caseation necrosis and macrophages and lymphocytes around the periphery. Multinucleated, primarily Langhans’ type, giant cells are present within these nodules.</spoiler>
* <spoiler text="What are epithelioid cells?">Epitheliod cells are tissue macrophages that have an epithelium-like appearance.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/230802-overview eMedicine Medical Library: Tuberculosis]
* [http://www.merckmanuals.com/professional/infectious_diseases/mycobacteria/tuberculosis_tb.html Merck Manual: Tuberculosis]
=== Journal Articles ===
* Rodrigues DS, Medeiros EA, Weckx LY, Bonnez W, Salomão R, Kallas EG. [http://www.ncbi.nlm.nih.gov/pubmed/11982602 Immunophenotypic characterization of peripheral T lymphocytes in Mycobacterium tuberculosis infection and disease]. ''Clin Exp Immunol'' 2002 Apr;128(1):149-54.
* Horsburgh CR, Barry CE, Lange C. [http://www.nejm.org/doi/full/10.1056/NEJMra1413919 Treatment of Tuberculosis]. ''NEJM'' 2015 Nov 26;373:2149-2160.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/259-tuberculosis PEIR Digital Library: Tuberculosis]
* [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html#4 WebPath: Granulomatous Lung Disease]
== Related IPLab Cases ==
* [[IPLab:Lab 1:Tuberculosis|Lab 1: Lung: Tuberculosis (Caseous Necrosis)]]
* [[IPLab:Lab 6:Tuberculosis|Lab 6: Lung: Tuberculosis]]
{{IPLab 3}}
[[Category: IPLab:Lab 3]]