Tuberculosis in a young baseball player

This report of a 19-year-old pitcher with chest pain illustrates how an atypical presentation of pulmonary tuberculosis in an athlete can delay diagnosis. In addition to a history, physical examination, and chest radiographs, the tuberculin skin test is the key to diagnosis of this disease. Laboratory work includes blood tests, liver and renal function studies, analysis of aspirated fluids, and sputum cultures. Treatment generally consists of daily doses of isoniazid, rifampin, pyrazinamide, and ethambutol or streptomycin. Screening close contacts such as teammates is essential; prophylaxis using isoniazid must be initiated for those who test positive.