Severe Post-Tuberculosis Bronchiectasis With Bullous Lung Disease Complicated by Acute Infective Exacerbation: A Case Report From Uganda.

We report a case of severe post-tuberculosis lung disease (PTLD) in a 60-year-old Ugandan man with a six-year history of suboptimally treated pulmonary tuberculosis (PTB), who presented with a three-week history of productive cough, yellow foul-smelling sputum occasionally streaked with blood, dyspnea, pleuritic chest pain, fatigue and progressive exercise intolerance. Imaging revealed extensive structural lung damage characterized by bronchiectasis, multiple bullae, and fibrotic changes, more pronounced in the left lung. Laboratory evaluation showed leukocytosis with neutrophilic predominance, and sputum culture grew Pseudomonas aeruginosa and Streptococcus pneumoniae. A diagnosis of post-tuberculosis structural lung disease complicated by acute infective exacerbation of bronchiectasis was made. Treatment with intravenous empirical antibiotics followed by culture-directed therapy, along with supportive care, led to clinical improvement and reduction in respiratory symptoms. This case highlights the severe structural sequelae of suboptimally treated PTB and the importance of early recognition and appropriate management of infective exacerbations, particularly in resource-limited settings.