Lung cancer and pulmonary tuberculosis (TB) are highly prevalent and representing major public health issues. They share common risk factors and clinical manifestations. It is also suggested that TB predicts raised lung cancer risk likely related to chronic inflammation in the lungs. However, it does not seem to influence the clinical course of lung cancer provided that it is properly treated. We present a case report of a 57-year old male with concurrent TB and lung cancer. He was diagnosed with positive sputum smear for acid fast bacilli (AFB) and subsequent culture of Mycobacterium tuberculosis. Besides, his comorbid conditions were chronic hepatitis C virus (HCV) infection and peripheral artery disease (PAD). Later while on anti-tuberculous treatment (ATT) squamous cell lung cancer (SCC) was confirmed with computed tomography (CT) guided biopsy. Due to poor general condition the patient was not fit for either surgery or radical chemo-and radiotherapy. He was transferred to hospice for palliative therapy. We want to emphasize that both TB and lung cancer should be actively sought for in patients with either disorder. In addition, there is no doubt that these patients with lung cancer and with good response to TB treatment should be promptly considered for appropriate anticancer therapy. Case reportThe interaction between lung cancer and tuberculosis (TB) has been long established [1]. There is good evidence that preexisting TB is independently associated with an increased risk of lung cancer [2]. Besides, solid-organ malignancy raises the likelihood of TB reactivation particularly in patients with old healed TB lesions [3].A 57-year old severe underweight (bodymass-index (BMI) 15 kg/m 2 ) male was admitted to a respiratory ward with a history of 3-week long anorexia, fatigue, purulent cough and 1-month long fever. His cough started 6 months before. He reported significant weight loss of 15 kilos for 6 months. He had no chest pain and haemoptysis. As an out-patient he received the course of amoxicillin with clavulanic acid with short-lived improvement. Also, the patient complained of intermittent claudication after a short walking distance. He was a resident of the shelter for homeless for a few years. His primary profession was a garage worker whereas his most recent occupation was garbage sorting. There was a history of heavy smoking (30-pack years) and alcohol addiction. He had not been drinking for last 2 years. He had no evident contact with a confirmed TB source. In the distant past he underwent an ear-nose-throat operation for the nose deformity. On examination, he was undernourished, nor-

Silicosis, a preventable occupational lung disease, is associated with various diseases, including tuberculosis (TB). There is an increased lifelong risk for lung tuberculosis even if exposure to silica dust ceases. That association contributes in a large extent to very high rates of tuberculosis in countries with poor TB and silica exposure control. We report a case of a male with a prior diagnosis of silicosis who was diagnosed with and treated for TB. Anti-tuberculous treatment was extended due to a positive sputum smear in the six th month of treatment. However, the culture of the sputum was negative. This case report highlights the value of thorough screening for tuberculosis in silicotic patients. The clinical management of these patients may be challenging due to frequent overlapping radiological features and uncertain results of TB treatment.

There is no doubt that venous thromboembolism (VTE) is a complex and multicausal disease. Tuberculosis (TB) itself is found to have thrombogenic potential. There is an association between tuberculosis and VTE. We present a case of a 31-year-old male diagnosed with TB after a 2-month delay. He was treated with an anticoagulant for pulmonary embolism (PE) complicated by pulmonary infarction, and with antibiotics for presumed bacterial pneumonia. The patient did not improve despite in-hospital treatment. Finally, TB was diagnosed with positive sputum smear for acid fast bacilli and subsequent culture of Mycobacterium tuberculosis. Antituberculous therapy was uneventful and the patient was discharged home. Thrombophilia screening revealed a heterozygous factor V Leiden mutation. This case report emphasises that although there is a steady decline in active cases of TB, it should be still placed high on the list as a differential diagnosis in non-resolving lung infection or pulmonary infarction. This is especially relevant in cases with typical radiological findings located in the upper lobes. On the other hand, definitive diagnosis may be challenging in a case of concurrent TB, bacterial pneumonia and pulmonary infarction. Thromboembolic events may develop in TB patients without any clinical VTE risk factors. Therefore, thromboprophylaxis should be cautiously considered in this group of patients.

The present report describes the coincidence of pulmonary tuberculosis (TB) and metabolic disorder such as diabetes. A patient’s bronchoalveolar lavage was found to be positive for acid-fast bacilli (AFB) with following growth of Mycobacterium tuberculosis and complete sensitivity to first line anti-TB drugs. At the same time, the patient presented with typical diabetes manifestation and subsequently required insulin therapy. Combined treatment resulted in significant clinical im- provement and gradual resolution of both TB and diabetes symptoms. Therefore, we would like to highlight the value of appropriate medical management of these disorders sharing at least some clinical symptoms and signs such as weight loss and fatigue. Moreover, a growing body of evidence indicates that diabetes may play a role as a risk factor for TB. Consequently, the increasing diabetes prevalence may be a danger to TB control.

A 45-year-old nonsmoking male patient was admitted with a nonproductive cough. He was in the follow-up for sarcoidosis stage II for 2 years. This was based on computed tomography findings of enlarged mediastinal lymph nodes and multiple small scattered nodules. Fine-needle aspiration of the left paratracheal lymph node revealed epithelioid histiocytes and multi-nucleated giants cells. Smear and culture for acid-fast bacilli (AFB) of bronchial washings and lymph node aspirate were negative. As the patient was asymptomatic with normal respiratory function tests, he was under observation.On the current admission, the physical examination was unremarkable. The erythrocytes sedimentation rate was 8 mm/hour. There was a very large number of parenchymal nodules mainly in the upper and perihilar zones in his chest X-ray (CXR), with parenchymal fibrotic changes (Figure 1). Smear for AFB of bronchial washings was negative. After 8 weeks, the culture on Löwenstein-Jensen medium of bronchial washings was positive for AFB. Anti-tuberculous treatment (ATT) was started. Drug susceptibility testing showed sensitivity to all first-line drugs. He tolerated the ATT well. There was no improvement on radiological imaging. He was discharged and treated as an out-patient in a continuation phase. The smear-negative samples after 2 and 6 months were culture negative. The CXR after the completion of the ATT did not show an improvement. He was seen in the out-patient department till the completion of the ATT. Then he was lost for further follow-up.