Difficulties of the stage-by-stage surgical treatment of a teenager with bilateral advanced fibrotic-cavernous tuberculosis. Сlinical case

BACKGROUND: To achieve success in the management of adolescents with tuberculosis, a comprehensive approach including surgical intervention is needed so as to eliminate disease clinical manifestations, to achieve persistent healing of tuberculous changes with restoration of bodily functions and complete social rehabilitation

CLINICAL CASE DESCRIPTION: In patient U., 17 y.o., sudden and acute onset of the disease broke out after her contacts with her aunt who had tuberculosis. The initial form was infiltrative pulmonary tuberculosis in the decay phase. A course of anti-tuberculosis therapy was prescribed considering the bacteria sensitivity to antibiotics. After the course, fibrous lesions and cavities were detected in both lungs at computed tomography examination of the chest organs. A personalized therapy was developed for the patient with consideration of her body weight and sensitivity to bacteria. In 7 months, an endobronchial valve was inserted at the bronchus mouth in the right superior lobe because of the large cavity in the right upper lung lobe and lack of changes in the cavity size. In six more months, the blocker was removed due to the lack of dynamics, and a video-assisted thoracoscopic combined resection of the right lung (upper lobectomy with resection of part S_V, anatomical resection S_VI with part S_VIII) was performed. On analyzing surgical material, it was found out that the patient was resistant to Isoniazid, Rifampicin and fluoroquinolones, so therapy was corrected. In six months, a video–assisted thoracoscopy combined resection of the left lung (S_I–III anatomical resection and marginal resection of S_VI part) was made.

CONCLUSION: After the performed treatment, patient's oxygenation improved, persistent abacillation was achieved, due to which the patient could return to normal lifestyle.