A 35-year-old woman presents to the pulmonologist’s office for evaluation of hemoptysis which has persisted for the past 2 months. She was diagnosed with pulmonary tuberculosis 2 years ago and received anti-tuberculosis treatment for 9 months. Three months ago, she was hospitalized due to recurrent hemoptysis, and she underwent bronchial arterial embolization. However, she has continued to have hemoptysis since that time. She denies fever, shortness of breath, palpitations, or loss of consciousness. Past medical history is significant for tuberculosis and major depressive disorder. Family history is significant for hypertension in her father diagnosed at age 52 years. She does not smoke but drink occasionally. She does not take any medications but does take a daily multivitamin. Vital signs are within normal limits. Physical examination reveals mild conjunctival pallor and is otherwise unremarkable. A chest x-ray is ordered and reveals a large cavity in the right upper lobe though there is no change compared to the x-rays taken at the end of tuberculosis treatment two years ago. An acid-fast bacillus smear of the sputum done at a previous appointment one month ago showed negative results.
Which of the following is the most appropriate next step in the management to stop hemoptysis from happening again?
- A) Broad-spectrum antibiotics
- B) Lobectomy
- C) Inhaled betamethasone
- D) Tranexamic acid
- E) Treatment for reactivation tuberculosis
Min Gyu Kim
Dr. Ted O'Connell