Tuberculosis presenting with generalized lymphadenopathy, pulmonary infiltrates, and bone destruction in a young man

Although tuberculosis is still relatively common in Canada, particularly among recent immigrants, one tends not to consider it very strongly in the absence of definite pulmonary symptoms and in the face of negative smears of expectorated sputum and bronchial washings. We present the case of a young immigrant from Ethiopia who presented with mild constitutional symptoms, bony tenderness of the chest wall, generalized lymphadenopathy, and rib erosions--a set of features which, in the face of smear-negative sputum and bronchial washings, raised a possibility of lymphoma. Eventually, diagnosis of tuberculous lymphadenitis and osteomyelitis was established and the patient responded well to appropriate therapy.