Radiologic Deception: A Case Report of Tuberculosis with Nodular Onset and Cystic Conclusion

Area of Science:

• Pulmonology
• Infectious Diseases
• Radiology

Background:

• Cystic lung disease is a rare manifestation of pulmonary tuberculosis (TB).
• It often mimics other diffuse cystic lung disorders, delaying diagnosis.
• Pulmonary TB can present with diverse and unusual radiological findings.

Purpose of the Study:

• To report an unusual case of cystic lung transformation during antituberculous therapy.
• To highlight the importance of serial imaging in diagnosing rare TB manifestations.
• To emphasize the need for vigilance in TB-endemic areas for cystic lung changes.

Main Methods:

• Case report of a 25-year-old woman with progressive dyspnea and pleuritic chest pain.
• Initial and follow-up high-resolution computed tomography (HRCT) imaging.
• Clinical correlation with antituberculous therapy initiation and progression.

Main Results:

• Initial imaging showed miliary nodules without cystic changes.
• Follow-up HRCT revealed transformation into thin-walled cysts with ground-glass opacities and tree-in-bud pattern.
• Radiological evolution occurred posttreatment initiation, suggesting immune-mediated processes.

Conclusions:

• Cystic lung transformation is a rare, potentially reversible complication of pulmonary TB.
• This presentation mimics other cystic lung diseases, necessitating careful diagnosis.
• Serial imaging and clinical vigilance are vital for managing this rare TB manifestation.