Tuberous sclerosis-rare presentation as pneumothorax

ABSTRACT

A 33 years old lady was admitted in Pulmonology unit of the Post Graduate Medical Institute, Lady Reading Hospital Peshawar on September 6, 1999 with the complaints of dry cough, fever off and on and left-sided chest pain for the last five months. The pain started suddenly and was not related to exertion. There was no history of haemoptysis or weight loss. Her appetite was good. She used to get breathless on exertion. She gave a history of repeated attacks of epileptic fits since childhood. She consulted many physicians and the diagnosis of Pulmonary Tuberculosis with epilepsy was made for which she received treatment. She did not improve with the treatment. On physical examination, her pulse was 96 beats per minute and her blood pressure was 120/80 mm Hg. She was not anaemic and her temperature was normal. Her JVP was normal and lymph nodes were not enlarged. She was not cyanosed. Her chest examination revealed hyper resonant percussion note on the left side and breath sounds were decreased on the same side. There were no added sounds. Examination of other systems did not disclose any abnormality. Her laboratory investigations showed an Hb level of 12.4 g/dl, a fasting blood sugar level of 100 mg/dl and serum calcium of 9 mg/dl. Renal function tests were normal, serum electrolytes were normal, ECG and Echocardiography were normal. The diagnosis of Tuberous Sclerosis with left-sided pneumothorax was made. She was intubated and the lung got expanded in 6 days without any complications