Mrs. Naleymo, aged 56 years from Bhutan, was referred to Fortis Hospital Anandapur from the Jigme Dorji Hospital in Thimpu by the Royal Government of Bhutan. The patient was a known case of tubercular lung about 4 years ago and had completed the full course of anti-tubercular treatment at that time. However, had been suffering from haemoptysis ie sputum with blood stains, which sometimes also aggravated to moderate amount of haemoptysis, for the past 6 months. On being investigated, she was found to have a large post-tubercular cavitating lesion bronchiectasis in the left upper lobe of the lung. In that cavity, there was also a large fungal ball, which was seen only in the CT-Scan and X-Ray. Here, the routine investigations were conducted along with the CT-Scan, which showed fungal ball in the left upper lobe. The lower lung was free of infection and bronchiectasis, and was completely normal on the left side. She had very high TSH, for which she administered medicine for 6 weeks. After that, she was brought back for left upper lobectomy in the month of June.

On 24th June 2019, the patient underwent a left upper lobectomy, which was quite difficult as there were lot of adhesions in the lung and there was severe bronchiectasis in the left upper lobe, which had a large cavity and also had a fungal ball. So the left lobectomy was done and the doctors removed the infected lung. The post-operative recovery of this patient was pretty smooth and the patient was discharged on 30th June 2019.

Explaining why this case was significant, Dr. K.M. Mandana – Director of the Department of Cardiac Sciences at Fortis Hospital Anandapur exclaimed, “This was a really challenging case, which is not really common these days, due to timely treatment of tuberculosis. Moreover, now-a-days, there is rarely any incidence of patients developing bronchiectasis or fungal infections in the lungs. What gives this thoracic case even more significance is that, unlike general cases, where lung resection is conducted for tubercular empyema, for decortication for empyema or for resection of cysts in the lung, this procedure was carried out on a post-tubercular patient with a cavitating lesion in the lung, associated with presence of a rare fungal ball coupled with multiple incidences of life-threatening haemoptysis.


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