Interstitial lung disease (ILD) is a final common pathway of a broad heterogeneous group of parenchymal lung disorders. It is characterized by progressive fibrosis of the lung leading to restriction and diminished oxygen transfer. Clinically, the presenting symptoms of ILD are non-specific (cough and progressive dyspnea on exertion) and are often attributed to other diseases, thus delaying diagnosis and timely therapy. Clues from the medical history along with the clinical context and radiologic findings provide the initial basis for prioritizing diagnostic possibilities for a patient with ILD. An accurate prognosis and optimal treatment strategy for patients with ILDs can only be after an accurate diagnosis. This review will assist pulmonary physicians and medicine specialist in recognition of ILD. Extensive literature search has been made through PubMed and also Book References has been used for writing this review.

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Background: As infected children represent a large proportion of the pool from which tuberculosis (TB) cases will arise and its associated risk factors that influence TB infection are basic cause for burden of TB. Aim: This study was to determine the prevalence of latent TB and associated risk factors in children less than 5 year of age in Karachi, Pakistan. Setting and Design: Cross-sectional study and it was conducted in tertiary care hospital in Karachi. Materials and Methods: In this study, children who were living in contact with individuals who had proven smear-positive pulmonary TB cases were investigated. A tuberculin skin test (TST) was performed on each child. TST sizes ≥5 and 10 mm, respectively, were considered positive. Statistical Analysis: A random effects logistic regression model, which takes into account the clustering of contacts within households, was used to assess the relationship between the tuberculin response of the contact and risk factors. Results are reported as unadjusted and adjusted odds ratios and their 95% confidence intervals. The likelihood ratio test was used to assess the overall significance of risk factors, tests for trend, and tests for interaction. Results: The distribution of TST responses followed a bimodal pattern, with 135 (35%) children presenting a palpable induration. The risk of positive TST response in the child increased with the geographic proximity of the child to the individual with TB within the household and with the degree of activities shared with the individual with TB. Nutritional status and presence of a bacille Calmette-Guérin (BCG) scar were not independent risk factors for TST positivity in this population. On multivariate analysis, the effect of geographic proximity to the individual with TB, household size, and duration of cough in the index case persisted for TST responses ≥5 mm. Conclusions: Positive TST in a child reflects most probably TB infection rather than previous BCG vaccination. Contact tracing can play a major role in the control of TB in Pakistan.

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The concomitant occurrence of the two oldest mycobacterial diseases that is tuberculosis and leprosy in a single individual is not rare but has been infrequently reported. Herein, we report a case of 34-year-old laborer who concomitantly presented with both sputum positive pulmonary tuberculosis and lepromatous leprosy. The diagnosis of the two diseases was made simultaneously, which is again infrequent in literature. The treatment of leprosy warrants screening of individual for tuberculosis because multi-drug therapy for leprosy may lead to acquired drug resistance for rifampicin, which is a mainstem of anti-tubercular therapy.

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Background: Pakistan holds rank 8 ^th among the world countries in which high prevalence of tuberculosis (TB) is present. There is evidenced that up to 30% of close contacts of TB patients become infected and at least half of them progress to active disease. The aim of this study was to screen active contacts of sputum positive pulmonary TB (SS +ve PTB) among household contacts (HHCs) of TB patients in Karachi, Pakistan. Materials and Methods: Cross-sectional study, which was conducted at chest clinics of Karachi. Total 750 HHCs were screened out of which 135 diagnosed smear positive TB patients was registered as index cases (ICs) from July 2012 till March 2013. Logistic regression analysis was carried out to estimate the odds ratio (OR) of different associated factors. Results: Prevalence among males (6.1%) compared with female (5.6%). The crude OR for age less than 15 years was 0.28 (95% confidence interval (CI) 0.14-0.55). Eighty-eight HHCs (11.73%) were found to have SS +ve TB. Disease frequency was significantly higher in HHCs who were smokers (adjusted OR 36.41; 95% CI 12.07, 109.79), had age less than 12 years (adjusted OR 3.63; 95% CI 1.68, 7.86), and who lived in houses less than 80 square yards (adjusted OR 3.77; 95% CI 1.27, 6.05). Conclusion: The IC with positive sputum smear constitutes great risk for TB infection and disease in HHC. There is needed for contact tracing strategy in the high-risk population.

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A 70-year-old male with past history of treated pulmonary tuberculosis presented with clinical, radiological, and laboratory features suggestive of pseudochylopneumothorax and bronchopleural fistula. Acid-fast bacilli (AFB) staining and AFB culture of pleural fluid was positive. Pseudochylothorax is a rare sterile complication of long standing tubercular effusion. Pseudochylothorax in itself can get complicated by reactivation of tuberculosis and bronchopleural fistula. The occurrence of pseudochylopneumothorax due to bronchopleural fistula as in our case is a rare manifestation of reactivation tuberculosis.

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Neuroblastoma of the adrenal gland is an extremely rare tumor in adults. We present a case of 24-year-old male patient, who presented with left sided massive pleural effusion and mass at left upper abdomen. Imaging reported that a huge heterogeneously enhancing mass originating from left adrenal area extended to the left lower chest causing compression of the left lower lobe of lung and pleural effusion. The rarity of this tumor in adults prompted us to present this case.

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Idiopathic pulmonary fibrosis (IPF) is a diffuse interstitial lung disease of unknown etiology. The prevalence of lung cancer among patients with IPF may vary between 4% and 9%. In India, there are is reported cases of IPF associated with lung cancer. In this case report, a 65-year-old male presented with gradually progressive dyspnea and dry cough and his high-resolution computed tomography scan of thorax revealed usual interstitial pneumonia with left lower lobe lung mass. Computed tomography-guided fine needle aspiration cytology of the mass was suggestive of adenocarcinoma. Patient was treated with chemotherapy.

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