Managing Symptoms After Stopping Tuberculosis Treatment: A Patient's Journey

Symptoms after discontinuing medication for pulmonary bullae and pulmonary tuberculosis?

Thank you, Director Jian, for your previous response.
I completed six months of tuberculosis medication in early July.
On that day, I had a follow-up appointment where I underwent X-rays and a CT scan.
After reviewing the X-ray, the doctor said I could stop the medication.
However, since mid-April, I have frequently experienced sharp or tight sensations in my chest, and occasionally I have coughed up sputum with blood.
(I had inquired about this in my second post.) Even on the day I stopped the medication, these symptoms persisted.
The location of my chest pain is unusual; it is above the nipple, about the height of a fist, towards the outer side near the diaphragm area.
Both sides in this area hurt, and pressing on it causes pain (it feels like a penetrating pain in my back).
The doctor said it was muscle pain and not related to the lungs.
A few hours after returning home that day, I developed a fever and redness behind my ears, which had occurred since mid-April.
I had no choice but to take antipyretics.
I am wondering if stopping the tuberculosis medication was too early.
I have been taking antipyretics daily, and after a few days, I consulted another doctor.
The CT report revealed a 7 cm pleural effusion in the upper right chest.
I informed the doctor about my current fever and chest pain, and he prescribed antibiotics and antipyretics, as well as ordered blood tests for SCC and CEA, along with three sets of sputum tests.
After a week, I returned for a follow-up.
The sputum test came back negative, and the blood tests were normal, but I told the doctor that my chest pain and fever remained about the same.
If I stop taking antipyretics, the redness and heat behind my ears start again and spread throughout my body.
Now, the frequency of coughing up blood has increased, and I don’t know what to do.
1.
I am suspecting whether the pain on both sides of my chest could be extrapulmonary tuberculosis.
Can a CT scan detect that area?
2.
How should a pleural effusion in the lung be managed? Is it just a matter of continuous monitoring? It seems that X-rays are not clear, and some doctors say that a CT scan can be done every three months; is that correct?
3.
The blood I cough up is not from a cough; it occasionally appears when I clear my throat of phlegm.
I notice that when I haven't eaten or drunk water for a while, my throat feels inflamed, and when I clear phlegm, there is occasionally blood.
If there is a rupture in the bronchus, should I undergo bronchoscopy, or would imaging or a CT scan provide clearer information?
4.
Why does the fever always start behind my ears first? What could be the reason?

danxin, 40~49 year old female. Ask Date: 2018/07/22

Dr. Jian Shuntian reply Pulmonology

(1) In the case of chest pain, a CT scan should be able to identify any lesions.
(2) Without reviewing the CT scan, it is not possible to make a judgment; you may seek a second opinion from another pulmonologist or thoracic surgeon.
(3) Consider performing a bronchoscopy.
(4) It is necessary to check the body temperature first to confirm whether there is a fever or just a burning sensation.
Thank you.

Reply Date: 2018/07/22

More Info

Managing symptoms after stopping tuberculosis (TB) treatment can be a complex and challenging journey, especially when patients experience persistent or worsening symptoms. Your situation, marked by chest pain, fever, and hemoptysis (coughing up blood), raises several important considerations regarding the management of TB and its potential complications.

Firstly, it is crucial to understand that stopping TB medication prematurely can lead to a resurgence of the disease or the development of drug-resistant strains of the bacteria. The standard treatment for TB typically lasts for at least six months, and it is essential to follow the healthcare provider's recommendations closely. If you were advised to stop treatment after six months, it is likely that your healthcare team assessed that you were responding well to the therapy. However, the symptoms you are experiencing, such as chest pain and hemoptysis, warrant further investigation.

1. Possibility of Extrapulmonary Tuberculosis: Your suspicion regarding the potential for extrapulmonary TB (TB that occurs outside the lungs) is valid. While CT scans can provide valuable information about lung pathology, they may not always detect extrapulmonary manifestations. If there is a concern for extrapulmonary TB, additional imaging studies or diagnostic procedures may be necessary to evaluate other areas of the body.

2. Management of Pleural Effusion: The presence of a 7 cm pleural effusion (fluid accumulation in the pleural space) is significant and requires careful management. Depending on the characteristics of the fluid and your symptoms, your healthcare provider may recommend monitoring the effusion or performing a procedure to drain the fluid. This can relieve symptoms and help determine the underlying cause of the effusion through analysis of the fluid.

3. Hemoptysis Evaluation: Coughing up blood, even if it is not associated with a cough, is a concerning symptom that should be evaluated promptly. If there is a suspicion of bronchial rupture or other complications, a bronchoscopy may be indicated. This procedure allows direct visualization of the airways and can help identify the source of bleeding. Imaging studies like CT scans can also provide valuable information, but bronchoscopy is often more definitive for assessing airway pathology.

4. Fever and Systemic Symptoms: The recurrent fever you are experiencing, particularly localized to the area around the ear, may indicate an underlying infection or inflammatory process. It is essential to monitor your temperature and report any significant changes to your healthcare provider. The fever could be a response to the ongoing inflammatory process in the lungs or pleura, or it could be unrelated to TB.

In conclusion, it is crucial to maintain open communication with your healthcare team. If your symptoms persist or worsen, do not hesitate to seek further evaluation. Regular follow-ups, imaging studies, and possibly additional diagnostic procedures are essential to ensure that any complications are identified and managed promptly. Additionally, consider discussing your concerns about the duration of treatment and the potential for relapse with your healthcare provider, as they can provide tailored advice based on your specific situation. Remember, managing TB is a collaborative effort between you and your healthcare team, and your active participation in your care is vital for a successful outcome.

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