Regressive giant bullous emphysema in tuberculosis of adults.

In the last two years there have appeared several reports on large multiple bullae which develop in the parenchyma of one or both lungs, and tend to grow or to decrease and eventually disappear. This type of cavity is seen in tuberculous patients under treatment by antibiotics and/or chemotherapy, particularly in those receiving isoniazid. The relationship between the latter drug and the development of such cavities is so close that most writers attribute the formation of the bullae to the isoniazid although they offer no satisfactory explanation for the mechanism of their production. This phenomenon however should not specifically be due to isoniazid alone, since there are isolated reports of pseudocystic tuberculosis called pneumatocele in patients treated with streptomycin. Behamou, Levy Valensi and Mimouni (1947), Dufourt, Galy and Perrin (1950), Silverthone and Silverman (1950) and others cited by Dufourt’ have recorded such cases. There is even another report by Pruvost and co-workers2 who describe pseudocystic bilateral multiple cavities developing from an apical cavity but which did not regress. This case was not treated by antibiotics before the appearance of the pseudocysts. Recently Caffey has published reports on the possibility of the appearance of cysts or cyst like cavities in infants in whom these congenital bullae underwent spontaneous regression. Furthermore, it is already accepted that pseudocysts may develop after pulmonary abscesses and we have published a case of this occurrence although at that time did not realize that possibility.3 Staphylococcic infections may give rise to multiple cavities in the lungs and the possibility of multiple cavities following the course of miliary tuberculosis is also known. However, development of multiple large cavities with a trend to rapid enlargement and subsequent regression and disappearance has not been reported until recently. We must admit that these reports coincide with the use of isoniazid in tuberculosis. We have found 25 cases of bullae with the features mentioned recorded particularly in the European and South American literature. It is rather surprising that so distinctive a disease has not been more frequently reported in the United States. The reports are those of Jacob and co-workers,4 Rossignol et al,6 Etienne Bernard et al,#{176} and Jacob, Cartier and Treps5 in France; Pablo Purriel et al,7 in Uruguay; Di Filipo in Italy8 and Altman and Ornstein in the United States.’#{176}