Misdiagnosis of Tuberculosis

Abstract

Introduction: High incidence of tubercular cases in developing
countries, similar clinical presentation of tuberculosis and
malignancy, lack of adequate infrastructure, and lack of
proper follow up are the most common factors associated with
misdiagnosis.
Case Summary: A 72 years old male CAME with complains
of cough with expectoration for 2 month, intermittent fever
associated with chills and rigors for 1 month, loss of appetite
and weight, intermittent pain in right side of the chest for
1 month. Patient was a known smoker and alcoholic. On
auscultation bilateral air entry was decreased with occasional
rhonchi. Patient’s chest x-ray was suggestive of consolidation
in right upper zone of chest. His sputum was negative for
AFB from outside, patient started on ATT, 2 months prior to
date of admission from private clinic on empirical basis that
was continued till the date of admission. Patient showed no
improvement, even after 2 months of ATT. His chest X-Ray was
suggestive of right upper zone consolidation, patient had no
prior radiography for comparison. He was continued on ATT
as he had already taken treatment for 2 months from outside.
Patient was tested negative for sputum AFB 1 and 2, CBNAAT
and culture.
Patient presented to emergency after a gap of two months
in state of drowsiness with complains of breathlessness and
severe right side chest pain. He was intubated in emergency
and managed on ventilator support. Patient recovered and a
CECT thorax was done suggestive of likely possibility of right
lung upper lobe neoplasm with metastatic lymphadenopathy
with possibility of multiple liver and bilateral adrenal metastasis
and changes of chronic airways disease with fibro bullous
changes in bilateral upper lobe apical segments. The FNAC
was positive for malignant cells with features suggestive of nonsmall
cell carcinoma – (possibly adenocarcinoma). Patient was
further managed in the department of Radiation Oncology by
chemotherapy. We discuss the radiographical progression and
subsequent investigations required to make a proper diagnosis.
Conclusion: It is imperative to form a conclusive diagnosis
using available diagnostic modalities in smear negative
tubercular cases to avoid delay in management of other
possible life-threatening diseases like lung carcinomas.