Nisar Ahmed Rao.
Lithoptysis.
J Coll Physicians Surg Pak Jan ;12(9):558-9.

This is a case report of a young male who presented with recurrent haemoptysis and chronic cough. His sputum for acid-fast bacilli (AFB) smear was positive. While receiving anti-tuberculosis treatment, he expectorated multiple tiny stones (lithoptysis). This case report reminds us that broncholithiasis should be considered in the differential diagnosis of haemoptysis.

A 40 years old male, ex-smoker, farmer by occupation, was admitted in ward-2 of Ojha Institute of Chest Diseases, Karachi with the complaints of productive cough and fever off and on for two years, progressively increasing shortness of breath for one year and haemoptysis of 6 months duration. The fresh episode of haemoptysis was of last fifteen days. The amount of blood was mild but patient had expectorated a significant amount of blood. There was history of weight loss. In the past, he had history of meningitis ten years back, details of which were not known. He was an ex-smoker with history of smoking of 20 pack years. He quit smoking two years ago on his physician`s advice. He also gave history of smoking `charas and intake of `bhang`. He was on anti-tuberculosis drugs, though irregularly, for the last two years. Clinical examination revealed anaemia and bilateral coarse crepts with a small patch of bronchial breathing right upper chest. Chest X-ray revealed patchy and nodular infiltrates in both lungs along with cavitation especially at upper halves of both lungs. A provisional diagnosis of pulmonary tuberculosis with suspicion of multi-drug resistant was made. Sputum was sent for acid-fast bacilli (AFB) culture and sensitivity. His sputum for acid-fast bacilli, direct smear was positive and five drugs were started, i.e. Inj. Streptomycin, Rifampicin, Isonicotinic acid hydrazide (I.N.H), Pyrazinamide and Ethambutol. The next day patient expectorated a tiny stone along with blood. During his stay he kept on expectorating tiny stones (Figure 2) along with sputum and blood. He received antituberculosis treatment for 54 days with improvement in symptoms and gain in weight of four kilogram. He then left the hospital against medical advice.

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