Extensive Fibrosis and Calcification of the Lungs Secondary to Tuberculosis

A female patient who was 65 years of age came for a consultation at the respiratory medicine outpatient department, primarily complaining of severe breathlessness even on minimal exertion, chronic productive cough for 4 months, and generalized chest pain. A detailed history taking revealed a history of pulmonary tuberculosis (TB) 15 years back, during which the patient had taken antitubercular therapy for 3 months instead of the recommended duration of 6 months as per TB guidelines and stopped on her own. The X-ray of the chest in a posteroanterior view was done [Figure 1], which revealed bilateral extensive fibrosis (left more than right) along with widespread calcification scattered throughout the bilateral lung fields.Figure 1: X-ray of the chest view (posteroanterior view) revealing extensive lung fibrotic and calcific lesions bilaterallyMycobacterium TB is the causative agent for TB infection, with wide-ranging clinical presentations affecting almost all body systems and the lungs in particular, leading to pulmonary TB. Acute infection in TB has varying presentations ranging from predominantly upper lobe cavities with consolidation in immune-competent individuals to a predominantly bilateral interstitial pneumonia in immunocompromised individuals. However, untreated acute infection with TB often leads to devastating sequelae[1] that involve extensive lung fibrocalcific changes, as illustrated in our clinical image. Through this clinical image of the patient’s chest X-ray, we wish to illustrate the devastating consequences of untreated or inadequately treated pulmonary TB. Although fibrosis is a common post-TB sequelae, the unique feature of this image is the bilateral fibrocalcific changes in a defaulter of Anti-tubercular therapy with an immunocompetent status. Patients with TB who develop long-term pulmonary sequelae usually demonstrate unilateral lung involvement on chest radiography.[2] Such findings with extensive fibrosis and calcifications are chronic changes that are rarely found nowadays due to the improved and efficacious anti-tubercular regimen along with the directly observed treatment short course initiatives of the National TB Elimination Programme. Differential diagnosis: Diffuse Interstitial lung disease Extensive lung fibrosis Connective tissue disease-associated interstitial lung disease Chronic interstitial pneumonia Drug-induced pulmonary fibrosis. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.