ZyraDoc #55 - September 25, 2026

A 38-year-old male presents with a 6-week history of persistent productive cough, hemoptysis, drenching night sweats, low-grade afternoon fevers, and unintentional weight loss of 7 kg.

On physical examination, he appears chronically ill, emaciated, and exhibits bronchial breath sounds and post-tussive apical crackles over the right upper lung zone.

A chest radiograph demonstrates a cavitary lesion in the right upper lobe with surrounding patchy infiltrates, and sputum GeneXpert MTB/RIF assay detects Mycobacterium tuberculosis complex without rifampicin resistance.

Case Summary

Clinical Focus:

The diagnosis is Drug-Susceptible Pulmonary Tuberculosis (TB).

Aetiology/Cause:

Infection by Mycobacterium tuberculosis, an acid-fast, intracellular aerobic bacillus.
Inhalation of airborne infectious droplet nuclei generated by persons with active pulmonary TB during coughing, sneezing, or speaking.
Impaired cell-mediated immunity leading to reactivation of latent TB infection or primary progressive disease.

Clinical Features:

Chronic productive cough lasting >2-3 weeks, frequently accompanied by hemoptysis (blood-streaked sputum).
Constitutional B-symptoms: low-grade evening fevers, drenching night sweats, anorexia, and progressive weight loss.
Physical signs: localized crackles, bronchial breath sounds, or dullness to percussion over affected lung segments (typically apical/posterior upper lobes).
Chest wall or pleuritic pain if pleural involvement is present.

Diagnosis and Investigations:

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