CTICasesBilateral Thick-Walled Cavities from Alpha-Hemolytic Streptococcal Infection after Hookah Smoking
Imaging findings
CT demonstrates bilateral thick-walled cavitary lesions in both upper lobes in a 60-year-old woman transferred for suspected tuberculosis. Bronchoscopy was negative for fungal infection and tuberculosis. History revealed frequent visits to hookah bars using wet tobacco mouthpieces that grew alpha-hemolytic Streptococcus. Follow-up CT one month later shows improvement of the cavitary lesions with antibiotic treatment.
Key takeaways
Hookah smoking using shared wet tobacco mouthpieces can cause bacterial infection including alpha-hemolytic Streptococcal pneumonia, which can manifest with bilateral upper lobe thick-walled cavities clinically resembling tuberculosis. This uncommon cause of cavitary lung disease should be considered in patients who frequent hookah bars, particularly when standard TB and fungal workups are negative and there is a history of hookah use. Improvement with appropriate antibiotics confirms the bacterial rather than mycobacterial or fungal etiology.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Takayasu Arteritis with Acute Intramural Hemorrhage Mimicking Intramural HematomaAutoimmune
- Relapsing Polychondritis with Tracheal and Costal Cartilage InvolvementAutoimmune
- Large Right Upper Lobe Pulmonary Vein with Mass Effect on Bronchus IntermediusCongenital
- Pulmonary Alveolar Proteinosis — Geographic Crazy PavingAutoimmune
- Idiopathic Pulmonary Hemosiderosis with Severe Pulmonary HypertensionILD
- Dual Left Anterior Descending Artery (Dual LAD) Coronary VariantCongenital
- Multiple Myeloma with Pulmonary Plasmacytoma InvolvementNeoplastic
- Lateral Costal Artery Embolization Coils in a LIMA Bypass PatientIatrogenic
See all cases from September 14, 2017 →
Related Infection cases
- Angio-Invasive Aspergillosis with Air Crescent Sign (Doll's Eyes)
- Fibrosing Mediastinitis from Histoplasmosis with Cor Pulmonale
- Cryptococcus gattii Presenting as Solitary Lung Nodule with Leptomeningitis
- Nocardia Pulmonary Infection in Stem Cell Transplant Patient
- Pulmonary Mucormycosis (Rhizopus) with Bird's Nest Sign
- Pneumocystis jirovecii Pneumonia (PJP) with Upper Lobe Predominance