Tuberculosis Presenting as Multiple Pulmonary Nodules Mimicking Malignancy

Area of Science:

• Pulmonology
• Infectious Diseases
• Radiology

Background:

• Multiple pulmonary nodules often suggest metastatic malignancy, but a broad differential diagnosis is essential.
• Tuberculosis (TB) can present as multiple nodules, mimicking metastatic disease on imaging.
• Differentiating TB from malignancy requires careful clinicoradiologic and microbiologic correlation.

Purpose of the Study:

• To highlight a case where pulmonary tuberculosis mimicked metastatic malignancy.
• To emphasize the diagnostic challenges and the importance of microbiologic testing in such cases.

Main Methods:

• Case report of a woman in her 50s presenting with dyspnea and heart failure.
• Initial evaluation included imaging (revealing mediastinal lymphadenopathy and pulmonary nodules) and CT-guided biopsy.
• Subsequent re-presentation with fever and cough led to sputum studies for diagnosis.

Main Results:

• Initial CT-guided biopsy showed necrotizing granulomas, without malignancy or infection.
• Sputum studies ultimately confirmed pulmonary tuberculosis (TB) via AFB smear and MTB PCR.
• The patient was treated with standard antituberculous therapy.

Conclusions:

• This case underscores the importance of considering TB in the differential diagnosis of multiple pulmonary nodules.
• Microbiologic testing plays a critical role in establishing the diagnosis, particularly when invasive procedures are contraindicated.
• Maintaining a broad differential diagnosis is key in evaluating patients with pulmonary nodules.