A case of disseminated tuberculosis mimicking metastatic cancer

Abstract

BackgroundDisseminated tuberculosis (TB) or miliary TB is defined as lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli, which may then affect virtually any organ system. The multiple organ involvement in disseminated TB can mimic metastatic cancer and can make the diagnosis challenging. False negatives are common therefore repeating microbiologic and histologic samples is essential.Case reportWe report the case of a young immunocompetent patient presenting with multiple atypical extra-pulmonary TB involvement. The patient presented with pulmonary, pleural, bilateral testicular and multiple bone involvement including calcanerium abscesses. These lesions were initially described as metastasis by the radiologist. Therefore lymphoma and metastatic testicular cancer as well as TB were high on the differential in this young foreign-born male. Pleural, broncho-alveolar lavage, bone marrow and cerebrospinal fluid acid-fast bacilli smear and microbiologic culture were all negative. However the histologic examination of the trans-bronchial biopsy and pleural biopsy showed necrotizing granuloma and helped to narrow down the diagnosis. The patient improved with RIPE therapy.ConclusionThis case illustrates the diagnostic difficulty of disseminated TB with atypical organ involvement. Culture is the gold standard for diagnosing TB but is a long process and with 23% of culture negative TB in the United-States, the diagnosis sometimes relies on thoroughly ruling-out differential diagnosis and histologic examination.

Massive Disseminated Tuberculosis in an Immunocompetent Patient: Early Diagnostic and Empiric Treatment Approach from an Endemic Country: Indonesia (A Case Report and Literature Review)

“…A similar result was reported in a limited Ugandan resource setting, where constitutional TB symptoms, including fever, weight loss and excessive night sweats were significantly useful as clinical predictors of empirical anti-tuberculosis initiation in TB/HIV patients with a negative AFB smear (28). Five cases TB were treated empirically without initial microbiological evidence (3,5,9,14,15). Our review (4,(16)(17)(18)(19)(20)(21) found that the majority of cases (35%) diagnosed disseminated tuberculosis from a biopsy (7/20).…”

Multifocal tuberculosis simulating a cancer-a case report

“…TB is one of the most popular infectious diseases in China, each year, around 250,000 people died due to TB in China [4]. However, some of the patients with TB are hard to diagnosis, especially for those that mimic the cancers [5,6].…”

Ten Commandments for the Diagnosis of Bone Tumors

“…S6) (e.g., stress fractures and avulsion injuries) 24,25 Infection (►Fig. S7) (e.g., subacute osteomyelitis and tuberculosis) 26,27 Small benign bone tumors (e.g., fibrous cortical defect, bone island, fibrous dysplasia[►Fig. 3], hemangioma, enchondroma) Miscellaneous (e.g., periosteal/cortical desmoid and Paget's disease) 28 A variant of the "don't touch" lesion is the "wait-and-see" lesion.…”