β-Lactams against Tuberculosis — New Trick for an Old Dog?

Abstract

(Medicine): A 71-year-old man was admitted to this hospital be-cause of recurrent fevers, dyspnea, and hypoxemia, with associated fluctuating pulmonary infiltrates. The patient had reportedly been well until approximately 6 months before this admission, when fatigue, fever, chills, shortness of breath, and erythema in the right leg developed. He was admitted to another hospital. A chest radiograph showed band atelectasis in the left lower lobe. Computed tomography (CT) of the chest that was performed on the same day revealed multifocal bilateral ground-glass opacities throughout the lungs, consolidation in the lingula and lower lobes, and enlarged mediastinal lymph nodes. A diagnosis of cellulitis of the right leg was reportedly made. Therapy with doxycycline and cefazolin was begun; the pa-tient's condition improved, and he was discharged home with a plan to continue a 7-day course of the antibiotic agents. During the next 6 months, multiple episodes occurred that consisted of fatigue and decreased appetite, followed by chills, severe weakness, dyspnea, fevers (to a temperature of 39.4°C), and hypoxemia. During that time, the patient was admitted at least six additional times to two different hospitals. Multiple CT scans of the chest, the most recent of which had been obtained 6 weeks before this admission, showed improvement of the air-space opacities in the lower lobes but persistence of the upper-zone ground-glass opacities. Antibiotics were administered during the episodes, and symptoms improved within 1 to 4 days; without the administra-tion of glucocorticoids, the patient's condition returned to baseline within 8 days. No infectious causes were identified. Bronchoscopic examination with broncho-alveolar lavage (BAL) was performed 3.5 months before this admission, and the BAL fluid reportedly contained 30% neutrophils, 24% lymphocytes, 32% macro-phages, and 2% eosinophils; microbiologic testing and cytologic examination were negative. Results of transthoracic echocardiography were normal, and a videofluo-roscopic swallowing study revealed mild oropharyngeal dysphagia that cleared with spontaneous subsequent swallows. A diagnosis of possible hypersensitivity pneumonitis was made.