Asymptomatic course of the tuberculosis process on the background of malignant neoplasms of various localization

The immune response in both tuberculosis and ZNO has similar mechanisms. These diseases have similar clinical and radiological manifestations, which makes timely diagnosis difficult among the population. An observation from practice is presented – surgical verification of pulmonary tuberculosis and two types of tumors in a patient with a recurrent course of myeloma. Patient M., 50 years old, considered himself ill since August 2023, when he noticed pain in the ribs on the left, a CT scan of the chest revealed a few scattered foci in both lungs, large calcification in the upper lobe of the right lung, foci of lytic destruction of bone tissue in all vertebrae, ribs, sternum, shoulder blades and collarbones. He was examined by an oncologist, according to PET/CT data, it is a common osteodestructive process, additional formation in the apical sections S1-S2 of the left lung with an increased level of metabolic activity. He was further examined and diagnosed with Multiple myeloma. 3 courses of chemotherapy (CT) of the 1st line with the effect were performed. On 04/27/24, a stabilizing operation was performed on the spine with anterior access – strengthening of the anterior complex of the Th12 vertebra. On PET/CT: a CT picture of the subpleural compaction area (magnification from 13×8 mm to 16×9 mm) and large calcification of the upper lobe of the left lung without dynamics for 6 months. A sample with recombinant tuberculosis antigen was performed – a 22mm papule with a vesicle. Upon further examination, no data were received for the tuberculosis process. A therapeutic and diagnostic operation was performed in the amount of VATS resection S1, S4-5 of the left lung with lymphodisection L10, L11, L13. According to the results of histological examination: moderately differentiated adenocarcinoma S1 of the left lung with a mixed type of growth (areas of acinar, papillary and solid types of growth). There is a site in S4-5 that is suspicious of a microblast of a highly differentiated neuroendocrine lung tumor (typical lung carcinoid). The structure of the necrosis focus in S4-5 of the left lung and fibrosis foci in L11 are more consistent with post-tuberculosis changes. Microbiologically, MBT DNA was detected in the surgical material by PCR (in S1 and S5), and CM3 was detected by luminescent microscopy in 100p/sp (in S1) and 9 in 100p/sp (in S5). The sensitivity to HRFq was established by the SYNTHOL method. Anti-tuberculosis therapy has been deployed. Given the lack of data for the oncological process in the lymph nodes, the pT₁N₀M₀ stage has been established. The patient was kept under observation, and chemotherapy was not deployed. The patient continued tuberculosis treatment at his place of residence.

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