Abstract

Individuals diagnosed with diabetes mellitus (DM) are more likely to contract tuberculosis (TB) and frequently have worse outcomes^[1]. Two-thirds of the estimated 440 million people with DM are expected to come from low-income nations by 2030^[2]. Co-occurring disorders like diabetes mellitus can exacerbate tuberculosis. DM is the most common co-morbid condition in the field of pulmonary tuberculosis. Compared to the general population's 0.8% risk of contracting TB, patients with diabetes have a 4.8% risk of doing so^[3]. Individuals with unmanaged diabetes mellitus show increased susceptibility to tuberculosis. DM is a moderate to strong risk factor for the onset of tuberculosis, according to numerous studies^[4][5]. DM patients who require more than 40 units of insulin per day are specifically twice as likely to likely to contract TB^[6[Hyperglycemia plus cellular insulinopenia increases vulnerability to Mtb-induced diseases directly]. When it comes to lung field involvement on radiography, DM patients with TB typically show lower lung field involvement, while non-DM patients typically show more upper lung field complications ^[7][8].

In this intricate case report, we present a case of a 39-year-old female with a longstanding history of Type 2 Diabetes Mellitus which is managed by anti-diabetic medication along with insulin, who presented with pulmonary symptoms reminiscent of pneumonia and was later diagnosed with Tuberculosis (TB), she battled pleural TB six years prior and completed treatment, but also shed light on the immediate metabolic peril of Diabetes Ketoacidosis (DKA). This multidimensional case emphasizes the diagnostic conundrum when chronic metabolic conditions intersect with acute infectious and metabolic entities.