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.
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