Case Report: Tuberculosis Autoregression after Minimal Treatment and Review of the Literature

Abstract

Mycobacterium tuberculosis (Mtb) is a complex pathogen causing multiple possible disease states in its host including latency, active disease, and elimination. While there is reasonable indirect evidence of elimination of tuberculosis (TB) in the absence of treatment, direct reports of autoregression are rare. We report a case of smear-negative, polymerase chain reaction (PCR)-positive TB disease regression in the absence of therapy due to severe adverse effects from antimycobacterial drugs. Indirect reports of TB autoregression, or self-cure, in the literature are reviewed, and an updated framework for conceptualizing Mtb infection is discussed.

Figure 1.

Computed tomography (CT) of thorax from March 4, 2019, demonstrating 6 mm right upper lobe pulmonary nodule, mediastinal lymphadenopathy, and large right-sided pleural effusion with pleural thickening.

Figure 2.

Computed tomography (CT) of thorax from June 3, 2019, demonstrating increase in size of right upper lobe pulmonary nodule to 1.8 × 2 cm. Interval decrease in pleural effusion. Stable lymphadenopathy.

Figure 3.

Computed tomography (CT) of thorax from December 21, 2019, demonstrating interval decrease in size of right upper lobe pulmonary nodule to 1.6 × 1.0 cm, resolution of pleural effusion. Stable lymphadenopathy.

Figure 4.

Computed tomography (CT) of thorax from July 14, 2020, demonstrating slight interval decrease in size of right upper lobe pulmonary nodule to 1.5 cm. Stable lymphadenopathy.

Figure 5.

Computed tomography (CT) of thorax from April 25, 2021, demonstrating continued interval decrease in size of right upper lobe pulmonary nodule to 1.2 cm. Resolution of previously noted right sided pleural thickening.