Post-tuberculosis Destroyed Lung Syndrome: A Case Report and Review of Management Challenges

Abstract Tuberculosis (TB) is a significant global health challenge, affecting millions each year. Since 2000, around 75 million individuals have survived TB, but many face long-term consequences, including post-tuberculosis destroyed lung syndrome, affecting approximately 1.3% of treated patients. This condition results in considerable respiratory morbidity and challenges. We present a 28-year-old Colombian female with a history of pulmonary TB treated with a 9-month regimen two years prior to admission. She presented with persistent left-sided chest pain, dyspnea, palpitations, and fatigue. She denied hemoptysis, night sweats, or weight loss. Physical examination revealed an afebrile patient with tachycardia (HR 111) and no hypoxia. Laboratory tests indicated leukocytosis (WBC 14.2) with normal cardiac markers. Imaging studies showed extensive lung damage, including large bullae and a small pleural effusion. Computed tomography angiography (CTA) excluded pulmonary embolism but revealed significant bullae, the largest measuring 12.0 x 8.7 x 12.8 cm. Despite negative cultures for MRSA, COVID-19, and QuantiFERON, the patient was empirically treated with Vancomycin and Zosyn for a suspected lung abscess. Bronchoscopy indicated normal bronchial anatomy with negative cultures. Following the exclusion of active TB, she was discharged on Levaquin and Flagyl with outpatient pulmonology follow-up. Post-tuberculosis destroyed lung syndrome is a severe complication stemming from the interplay between Mycobacterium tuberculosis and the host immune response, leading to chronic inflammation and lung damage. It can significantly impair lung function, diminish quality of life, and increase healthcare utilization, necessitating a comprehensive management strategy. Diagnosis relies on a detailed clinical history, imaging studies, and a high index of suspicion, as standard tests may overlook residual TB effects. Symptoms are often misattributed to other causes, resulting in treatment delays. Management typically involves pharmacotherapy for infections and bronchial obstruction, alongside pulmonary rehabilitation to enhance capacity. In advanced cases, surgical intervention may be necessary. As tuberculosis re-emerges in previously low-incidence regions, it is vital for healthcare providers to increase awareness of its complications. Enhanced diagnostic strategies, targeted therapies, and comprehensive follow-up can improve outcomes. By addressing the long-term consequences of tuberculosis, we can better serve our patients and mitigate the public health impact of this persistent disease.