Misdiagnosis of a multi-organ involvement hematogenous disseminated tuberculosis as metastasis: a case report and literature review

Abstract

Background Tuberculosis (TB) is a great mimicker and diagnostic chameleon, and prone to be diagnosed as malignancy. Even though many reports have described the differences between pulmonary TB and lung cancer, the atypical systemic hematogenous disseminated TB (HDTB) is very rare and more confusing in clinical practice. Case presentation A 73-year-old man, HIV-negative, was hospitalized to the local county hospital because of chest pain, low-grade fever, asthenia, anorexia and weight loss for the pasting two months. The CT findings of the two lungs showed multiple round or round-like nodules of different sizes, with clear boundaries and partial fusion. The level of serum CA19–9 was significantly higher than normal, and progressively increased. There were multiple enlarged lymph nodes in the neck, mediastinum, abdominal cavity and pelvic cavity. The symptoms were diagnosed as hematogenous spread of gastrointestinal tumor in the local county hospital. However, when transferred to our provincial hospital, through comprehensive dynamic analysis, this patient was diagnosed as atypical systemic HDTB, no cancer at all. Through routine anti-TB therapy for one year, the patient was recovered very well at the follow-up of half year after withdrawal. Conclusions In the past, most TB misdiagnosis cases involved in single organ and were finally confirmed through invasive examination. This case enriched clinical experiences in the diagnosis of atypical HDTB. We encouraged clinicians to establish a dynamic thinking for diagnosis and treatment and emphasized the value of biopsy and 18F-FDG-PET in distinguishing TB and cancer.

Cancer or Tuberculosis: A Comprehensive Review of the Clinical and Imaging Features in Diagnosis of the Confusing Mass

“…CT scans of early miliary dissemination commonly feature ground-glass opacification with barely discernible nodules, followed by discrete miliary nodules representing round intrapulmonary lesions of <3 cm ( 50 ). Multiple pulmonary nodular lesions of varying sizes usually lead to misdiagnosis, especially when complemented by non-specific symptoms ( 2 , 26 , 32 ). In some tuberculosis cases, chest CTs showed multiple round nodules of different sizes, with clear boundaries and partial fusion ( 2 ).…”

“…Multiple pulmonary nodular lesions of varying sizes usually lead to misdiagnosis, especially when complemented by non-specific symptoms ( 2 , 26 , 32 ). In some tuberculosis cases, chest CTs showed multiple round nodules of different sizes, with clear boundaries and partial fusion ( 2 ). In addition, chest CT scans have also shown pneumonia in patients with cancer.…”

“…Hence, this indicator has low specificity. In the misdiagnosis of cancer and tuberculosis, sharply increased CA 19-9 levels also play a key role ( 2 ). CA 19-9 was reportedly elevated in cases of pulmonary tuberculosis ( 70 ), hematogenous disseminated tuberculosis ( 2 ), and pancreatic tuberculosis ( 34 , 71 ).…”

“…In 2020, an estimated 1,806,590 new cancer cases and 606,520 cancer-related deaths were estimated to occur in the USA. Tuberculosis is a great mimicker and diagnostic chameleon and is prone to be diagnosed as cancer ( 2 ). Moreover, due to its unusual presentations and lack of specific diagnostic tests, patients with cancer have been misdiagnosed with tuberculosis ( 3 , 4 ).…”

The first report of co-existence of pulmonary tuberculosis and lung malignancy in a kidney transplant recipient. A case report and literature review

“…However, among different TB types, smear-and culture-negative TB is especially hard to make a de nite diagnosis. Additionally, the clinical and radiological features between TB and cancer are very similar, which often lead to misdiagnosis and delayed treatment [9]. Thus, every case with de nite diagnosis and different characteristics is valuable for the clinicians.…”