Cavitary lung lesions.

A 64-year-old man presented with unintentional weight loss of 22 kg in the preceding 9 months, cough, night sweating and low-grade fever. The lag time between onset of symptoms and first medical visit was explained by a long history of homelessness and intravenous drug abuse. Posteroanterior chest radiogram showed biapical large cavities (Fig. 1, arrows), as well as reticulo-nodular opacities, volume loss in left lung and pleural thickening. Computed tomography (Fig. 2) highlighted the thick-walled cavities and their bronchial communication (arrow) suggesting endobronchial spread of an infectious process.1 On the basis of these findings the diagnosis of postprimary tuberculosis was supposed and confirmed with positive smear and culture results. Human immunodeficiency virus testing was negative. A successful treatment protocol of isoniazid, rifampicin, pyrazinamide and ethambutol was administered. Despite a sustained minor reduction of the incidence of TB in developed countries, it is still challenging, even in the 21st century mainly by HIV co-infection, substance abuse and emergence of drug-resistant tuberculosis.2,3