Pulmonary tuberculosis in the elderly: diagnostic difficulties

Although numerous case reports and reviews have suggested that pulmonary tuberculosis presents atypically in the elderly, our findings argue for a basic similarity in the radiological pattern between younger and older patients, but a dissimilarity in the clinical presentation. Indeed elderly patients present with more non-specific complaints and have more negative tuberculin skin tests. The combination of these features and confounding (e.g. pseudo-tumoural) aspects of roentgenographic manifestations of pulmonary tuberculosis, even if the localization is apicoposterior, frequently result in more misdiagnosis in elderly patients. It may be suggested that non-specific complaints, even in the presence of normal chest X-ray or of minor lesions in the upper portion of the lung, should prompt careful examination. Tuberculosis should be considered more frequently in the differential diagnosis even when malignancy or other infections seem to be more likely.