Mumbai: A 10-year-old girl required part of her lung to be removed after a pen cap remained lodged near her left lower lobe bronchus for over seven years, as multiple doctors misdiagnosed her abnormal X-ray as tuberculosis or asthma.Speaking to TOI, the girl’s mother, Dharavi resident Maimuna Shaikh, said that when symptoms like a persistent cough and sudden weight loss appeared, several clinicians treated her for suspected infectious diseases and prescribed antibiotics. She was then referred to a BMC hospital, where doctors put her on presumptive TB treatment even though her sputum sample was negative.A resident doctor, who was with the hospital then and was partly involved in Mysha’s case, said this was likely one of the rare instances where an exact diagnosis was very difficult to establish given the location of the object, and treatment was provided based on clinical presentation.
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“We cannot just give out the Anti-Koch’s Therapy (AKT) regimen unless there is a strong indication. The treatment even with a negative result is useful for future doctors to rule out TB,” the doctor said.Even after the TB treatment, when Maimuna saw her child not getting any better, she took her to another private hospital, where doctors told the family Mysha had asthma and prescribed an inhaler for relief.Dr Indu Khosla, a pulmonologist at SRCC Children’s Hospital (Narayana Health) who was involved in the case, said that most doctors saw pneumonia that would not resolve and prescribed anti-TB medicines. “Further investigations for a foreign body inside the lung should have been suspected, but these are differences of opinion, and doctors cannot be blamed for it,” she said.She added that a CT scan showed a collapsed lung, and because the rest of the organ appeared normal, she suspected an external foreign body. “On the bronchoscopy, we saw a pen cap deeply embedded, we had to involve our ENT team and use more anaesthesia to be able to pull it out,” Dr Khosla said.As soon as it was removed, Mysha felt much better. “About two to three weeks after the procedure, her pneumonia, which involved the left lower lobe and the middle lobe, had reduced and was confined only to the lower lobe. The part of the lung that was not degenerated opened up,” Dr Khosla said.Doctors waited for a month to check if the rest of the affected lung would re-expand, but it did not. Because of heavy infection and irreversible tissue damage, they ultimately had to remove roughly one-third of her lung. Mysha is expected to live a normal life, but Maimuna said she almost lost her daughter to one clinical miss. “We have lost count of expenses so far,” she said.
