TUBERCULOUS PULMONARY GANGRENE - REPORT OF A CASE AND REVIEW

Pulmonary gangrene is an uncommon but life-threatening complication of bacterial pneumonia. Only four cases of pulmonary gangrene due to Myc obacterium tuberculosis have been described to date; another case of p ulmonary gangrene was attributed to unidentified mycobacteria. We repo rt a fatal case of tuberculous pulmonary gangrene (TPG) and review the literature on this infection. To our knowledge this is the first case of TPG documented by thoracic computed tomographic scanning. Radiolog ical features of pulmonary gangrene are distinctive, and identificatio n of pulmonary parenchyma in the mass on computed tomography may be co nsidered as pathognomonic. Analysis of the six cases revealed that mos t of the patients were aged, and one-half of them were alcohol abusers . Right-upper-lobe involvement predominated. When performed, sputum sm ears disclosed acid-fast bacilli. M. tuberculosis was cultured from sp utum or pathologic material in five of the six cases. Four patients (6 6.7%) died. Four of six patients with TPG received antituberculous the rapy, and two of them survived; no patient underwent surgical interven tion. Although surgical management has been successfully employed in c ases of bacterial pulmonary gangrene, TPG has always been treated with medical therapy alone. In spite of administration of antituberculous therapy, mortality is high.