Symptomatic bradycardia in tuberculosis-related giant bullae (vanishing lung syndrome): A case report

Rationale:Vanishing lung syndrome is rare and can be associated with a history of smoking and marijuana use. The occurrence of giant bullae can also be linked to infections, particularly tuberculosis in tropical countries.Patient concerns:A 26-year-old male complained of weakness, severe vomiting, and reduced breathlessness when lying on the left side. He had a history of pulmonary tuberculosis two years ago.Diagnosis:Symptomatic bradycardia in tuberculosis-related giant bullae.Interventions:The patient was recommended to undergo an elective bullectomy, but he decided not to proceed with the procedure. Atropine sulfate was administered to alleviate symptoms of bradycardia, while a standardized anti-tuberculosis regimen were started for the next six months.Outcomes:Following 7 days of intensive care treatment involving antituberculosis medications and atropine sulfate, the patient achieved hemodynamic stability, opting against bullectomy despite residual symptoms of dyspnea. Subsequent six months of antituberculosis therapy notably alleviated symptoms without requiring bullectomy.Lessons:Increasing intrathoracic pressure can also be caused mechanically by giant bullae. Cardiac symptoms in vanishing lung syndrome are reversible and can be alleviated once the underlying cause is addressed. In this case, symptomatic bradycardia was reduced only with tuberculosis treatment without bullectomy intervention.