When the Great Masquerader Reveals Itself-Tuberculosis

Pneumonia is a clinical diagnosis often treated empirically and successfully on an outpatient basis. When a patient fails to improve, the clinician is left to revisit the differential of pathogens and reconsider the host. Admission, imaging, and invasive and noninvasive testing are part of the toolkit for the severe or atypical case of pneumonia. For fastidious organisms, achieving a culture-proven diagnosis can be quite difficult. This article discusses the screening and testing for tuberculosis, reviews the utility of computed tomography imaging and bronchoscopy with bronchoalveolar lavage in severe or atypical pneumonia, and highlights the barriers to definitive diagnosis even when the causative microbe is on the differential diagnosis when a patient is admitted. [Pediatr Ann. 2017;46(2):e51-e55.].