Pulmonary tuberculosis (TB) and lung malignancy can mimic each other in clinical presentation and sometimes in radiological imaging. Delayed or overdiagnosed of TB may cause a delay in treatment, unwanted adverse drug reactions, and increased morbidity. Here, we report an interesting case of conflict clinicoradiololgical presentation. In this case, the clinical features were consistent with infective etiology, while the radiological imaging favored lung malignancy. The final diagnosis of primary drug-resistant pulmonary TB was established based on GeneXpert in bronchial washing. The patient was put on treatment and follow-up under the national program. On follow-up, the patient showed clinical improvement in terms of symptoms resolution and weight gain. This case depicts the atypical presentation of drug-resistant TB and highlights the role of invasive procedures in clinicoradiological discordant cases of TB and malignancy.
Kumar N, Bhargava SK, Agrawal CS, George K, Karki P, Baral D. Chest radiographs and their reliability in the diagnosis of tuberculosis. JNMA J Nepal Med Assoc 2005;44:138-42.
Cohen R, Muzaffar S, Capellan J, Azar H, Chinikamwala M. The validity of classic symptoms and chest radiographic configuration in predicting pulmonary tuberculosis. Chest 1996;109:420-3.
Kebede W, Abebe G, Gudina EK, Kedir E, Tran TN, Van Rie A. The role of chest radiography in the diagnosis of bacteriologically confirmed pulmonary tuberculosis in hospitalised Xpert MTB/RIF-negative patients. ERJ Open Res 2021;7:00708-2020.
Rolston KV, Rodriguez S, Dholakia N, Whimbey E, Raad I. Pulmonary infections mimicking cancer: A retrospective, three-year review. Support Care Cancer 1997;5:90-3.
Chuchottaworn C, Thanachartwet V, Sangsayunh P, Than TZ, Sahassananda D, Surabotsophon M, et al. Risk factors for multidrug-resistant tuberculosis among patients with pulmonary tuberculosis at the central chest institute of Thailand. PLoS One 2015;10:e0139986.
Wáng YX, Chung MJ, Skrahin A, Rosenthal A, Gabrielian A, Tartakovsky M. Radiological signs associated with pulmonary multi-drug resistant tuberculosis: An analysis of published evidences. Quant Imaging Med Surg 2018;8:161-73.
Horeweg N, van Rosmalen J, Heuvelmans MA, van der Aalst CM, Vliegenthart R, Scholten ET, et al. Lung cancer probability in patients with CT-detected pulmonary nodules: A prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol 2014;15:1332-41.
Callister ME, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, et al. British thoracic society guidelines for the investigation and management of pulmonary nodules. Thorax 2015;70 Suppl 2:i1-54.
Paramasivam S, Thomas B, Chandran P, Thayyil J, George B, Sivakumar CP. Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Kerala. J Family Med Prim Care 2017;6:643-8.
