[A particular case of tubercular pneumonia].

A 50 year old woman was seen for fever and persistent cough, with elevated phlogosis markers and a cavitary lesion at the right upper pulmonary lobe at thoracic CT. Even in the absence of any culture-positive finding, but given the strong suspicion of tubercular disease, the patient was treated with standard antitubercular quadruple therapy for two months (isoniazid, pyrazinamide, rifampin and ethambutol) and later with two-drug therapy (isoniazid and rifampin). One month after the beginning of this second regimen we observed clinical relapse and a rise in phlogosis markers. We supposed partial resistance to therapy and, without any antibiogram, we decided to introduce therapy with oral levofloxacin (stopped for polyneuropathy) and then oral linezolid. At the end of therapy we observed complete clinical and radiological healing. In our opinion this clinical case shows clearly the diagnostic and therapeutic issues of the tubercular disease: the need to start therapy even in the absence of positive cultures, the presence of resistance to conventional therapy and the possibility of alternative therapeutic regimes with oral antibiotics.