Title : Pulmonary tuberculosis parodying lower lobe lung malignancy!
BACKGROUND AND AIM: Tuberculosis is known to mimic several condition, especially malignancy. Pulmonary TB can present with pulmonary infiltration with or without mediastinal lymphadenopathy. TB often gets misdiagnosed in the countries having low incidence of TB with high incidence of cancer and varying clinical presentation which result in misdiagnosis and delay in treatment.
CLINICAL PRESENTATION: A 45 year old male who came with complaints of cough with expectoration for 1 month associated with streaks of blood, significant loss of weight and loss of appetite, no other positive history. Patient’s general condition was fair. vitals stable, respiratory system on auscultation showed fixed wheeze in right mammary area, other systemic examinations were normal.
INVESTIGATION: CBC, RLE was within normal range except for hypoalbuminemia, Chest x ray showed right lower zone opacity and CECT chest revealed a soft tissue mass in right lower lobe of size 5*6 cm with no lymphadenopathy.USG abdomen was normal.Sputum AFB and CBNAAT was negative. FOB showed ulcerative lesion, bronchial wash was AFB smear 2+. CT guided biopsy was done which showed caseating granulomatous lesion and part of sample sent in normal saline for CBNAAT turned out to be positive.
RESULT: Patient was diagnosed to have endobronchial and parenchymal tuberculosis. Patient was started on ATT, hypoalbuminemia correction done, advised to take high protein diet, patient followed up regularly, tolerating ATT, follow up imaging showed good resolution.
CONCLUSION: Thus Pulmonary Tb should be considered as a main differential diagnosis in patient with lung mass especially in area with high prevalence of tuberculosis that too who are immunocompromised. Early diagnosis and appropriate treatment will decrease the disease progression and improve the morbidity of the patient.