Opaque Hemithorax . Primary Tuberculous Pneumonia Presenting with Acute Respiratory Failure A Case Report & Review of the Subject

A young previously healthy male was hospitalized in intensive care unit due to progressively worsening dyspnea (mMRC grade 4), cough with scanty sputum and fever. He exhibited signs of acute respiratory failure including tachypnea (respiratory rate 40/m), cyanosis and oximetric oxygen saturation (SpO2) of 73 %. There was bronchial breathing on right hemithorax and coarse crackles on left side of chest auscultation. Chest radiograph was consistent with almost opaque right hemithorax with slight sparing of upper zone along with patchy air space shadowing involving the middle and lower zones of left lung. He received high flow oxygen, empirical broad spectrum antibiotics and had HRCT chest that showed large pneumonia involving almost complete right lung with air bronchograms and a small pneumonia on left side with ipsilateral pleural effusion (exudative lymphocytic). He was found to have primary tuberculous pneumonia because his sputum was positive for acid-fast bacilli (AFB ++) on Ziehl-Neelsen (ZN) staining and there was no bacterial growth on culture. His respiratory failure responded well to anti-tuberculosis treatment (ATT), broad spectrum antibiotics and corticosteroids and he was off oxygen after 10 days of intensive treatment.