National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 A 15-Year-Old Healthy Girl with Streaky Hemoptysis and Cavitary Lung Lesion 202 205 734854 EN Mitra Rezaei Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-7242-5839 Sana Sadat Pourhoseini Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0009-0005-8308-0142 Afshin Moniri Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0001-7237-8940 Forouzan Mohammadi Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-3774-5650 Payam Tabarsi Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-8932-5420 Majid Marjani Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0003-1466-8645 Journal Article 2025 08 19 WHAT IS YOUR DIAGNOSIS? A 15-year-old girl, otherwise healthy, presented with low-grade fever, cough, sputum with two episodes of streaky hemoptysis, and left side chest wall pain for a couple of months. Vital signs on admission included a respiratory rate of 18 breaths per minute, a temperature of 37°C, a heart rate of 110 beats per minute, and a blood pressure of 95/65 mmHg. Her physical exam was unremarkable. A chest X-ray showed suspected cavitary lesions in the left lung. A chest computed tomography (CT) scan showed bilateral nodular infiltrations (Figure 1A & 1B) along with cavitary lesions, especially in the left upper and left lower lobes (Figure 1C & 1D). In primary laboratory studies, the hemoglobin was 14 g/dL, the white blood cell count was 7200/µL, the platelet count was 165000/µL, and the erythrocyte sedimentation rate was 13 mm/hr. Liver and renal function tests and other biochemistry were normal. No microorganism was identified by blood and urine culture. The Inflammatory markers, such as Antinuclear Antibody (ANA), Cytoplasmic and Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (C-ANCA & P-ANCA), Anti-Cyclic Citrullinated Peptide (Anti-CCP), and Rheumatoid Factor (RF), were all negative. <span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Study of sputum and bronchoalveolar lavage for acid-fast bacilli (AFB), bacteria, and fungi was negative. Thus, CT-guided biopsy from the cavitary lesion was performed (Figure 2)<span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">. https://www.tanaffosjournal.ir/article_734854_32af976a961e95999d11c40382c49fbd.pdf