Misdiagnosis of Tuberculosis

Abstract

Introduction: High incidence of tubercular cases in developingcountries, similar clinical presentation of tuberculosis andmalignancy, lack of adequate infrastructure, and lack ofproper follow up are the most common factors associated withmisdiagnosis.Case Summary: A 72 years old male CAME with complainsof cough with expectoration for 2 month, intermittent feverassociated with chills and rigors for 1 month, loss of appetiteand weight, intermittent pain in right side of the chest for1 month. Patient was a known smoker and alcoholic. Onauscultation bilateral air entry was decreased with occasionalrhonchi. Patient’s chest x-ray was suggestive of consolidationin right upper zone of chest. His sputum was negative forAFB from outside, patient started on ATT, 2 months prior todate of admission from private clinic on empirical basis thatwas continued till the date of admission. Patient showed noimprovement, even after 2 months of ATT. His chest X-Ray wassuggestive of right upper zone consolidation, patient had noprior radiography for comparison. He was continued on ATTas he had already taken treatment for 2 months from outside.Patient was tested negative for sputum AFB 1 and 2, CBNAATand culture.Patient presented to emergency after a gap of two monthsin state of drowsiness with complains of breathlessness andsevere right side chest pain. He was intubated in emergencyand managed on ventilator support. Patient recovered and aCECT thorax was done suggestive of likely possibility of rightlung upper lobe neoplasm with metastatic lymphadenopathywith possibility of multiple liver and bilateral adrenal metastasisand changes of chronic airways disease with fibro bullouschanges in bilateral upper lobe apical segments. The FNACwas positive for malignant cells with features suggestive of nonsmallcell carcinoma – (possibly adenocarcinoma). Patient wasfurther managed in the department of Radiation Oncology bychemotherapy. We discuss the radiographical progression andsubsequent investigations required to make a proper diagnosis.Conclusion: It is imperative to form a conclusive diagnosisusing available diagnostic modalities in smear negativetubercular cases to avoid delay in management of otherpossible life-threatening diseases like lung carcinomas.