Title : Pulmonary Tuberculosis Mimicked as Metastatic Lung Carcinoma: A Case Report
Abstract:
Tuberculosis has been regarded as a great mimicker as it can imitate various disease entities. Clinicians must be aware of tuberculosis’s atypical clinical and radiologic manifestations, especially in areas where it continues to be a significant public health concern. This is a case of a 59-year-old female who presented with acute dyspnea She is a non-smoker, hypertensive, non-diabetic, non-asthmatic, no previous tuberculosis treatment nor exposure. Lung physical examination revealed decreased breath sounds on the left lung field. Family history was negative for lung malignancy but is positive for colon cancer. On initial workup, a chest radiograph showed massive pleural effusion on the left and she underwent chest tube thoracostomy insertion. Subsequently, chest CT-scan with contrast was done revealing 79.9 x 71.1 x 69.4 mm solid heterogeneous mass with irregular calcification at the left upper lobe and lingula and 73.1 x 67.5 x 65.0 mm right mid lung mass with multiple varisized irregular nodules on both upper lobes. There was also minimal left-sided pleural effusion. The initial impression was a possible pulmonary malignancy with metastasis. Video-assisted thoracoscopic surgery, deloculation with biopsy of the left upper lobe mass was done which showed loculated pleural effusion and drained 70cc serous pleural fluid. A yellowish, well-encapsulated mass was situated medially, slightly adherent to the left upper lobe. Multiple samples from the left upper lobe mass were taken and sent for rush frozen section, revealing caseating granulomatous inflammation consistent with tuberculous etiology. She was started on anti-TB medications and was discharged improved and stable.
What will the audience learn from your presentation?
• This atypical presentation of tuberculosis will add to the audience’s knowledge of the other radiologic manifestation of tuberculosis.
• In cases when clinicians are presented with a patient who appears to have lung malignancy on a chest radiograph, infectious causes such as tuberculosis must be included in the differential diagnosis.
• For the field of research, higher-level studies may be undertaken to investigate the incidence and prevalence of tuberculosis presenting like lung malignancy.
Biography of presenting author (should not exceed 100 words)
Dr. Shane B. Villamonte finished her pre-medical course, BS Medical Technology, at the University of Santo Tomas, Manila, the Philippines, in 2012 and received her medical degree at the same university in 2016. She had her post-graduate internship in 2017 at the University of Santo Tomas Hospital, Manila, Philippines, and completed three years of Internal Medicine residency at the same institution in 2020. Dr. Villamonte is currently in her 2nd year of Adult Pulmonary and Critical Care Medicine training at the same institution.
