Abstract
Introduction: Tuberculosis (TB) is a global health problem with alarming rate of morbidity and mortality. With its multitude presentation, it is considered a diagnostic chameleon as it may resemble several clinical conditions including malignancy, given similarities between the two conditions in terms of clinical and imaging features.
Case Report: Here we present an illustrating case of an 83-year-old nonsmoker male who presented with intractable cough of two months duration. The blood parameters and sputum reports were not contributory to a specific diagnosis. His computed tomography (CT) imaging findings suggested a heterogeneously enhancing mass in right lower lobe and favored a diagnosis of lung cancer. So, for confirmation he underwent a transcutaneous CT guided lung biopsy for the mass but interestingly on histopathological evaluation, it turned out to be tuberculosis.
Discussion: Tuberculosis is a communicable and preventable disease. Pulmonary TB (PTB) can mask or imitate lung cancer imaging features. A battery of tests is available to differentiate between the two, however, microbiological and histopathological results are the gold standard. An accurate diagnosis is must to initiate appropriate treatment and to avoid toxic chemotherapy and unnecessary surgery.
Conclusion: Pulmonary tuberculosis (PTB) can have an atypical radiological presentation where it counterfeits lung cancer imaging. The case highlights that a diagnosis of PTB should always be considered in a TB endemic country like India.
Keywords: Pulmonary tuberculosis, Lung cancer, Contrast enhanced computed tomography.
References
- World Health Organization. Global tuberculosis report, 2023. Geneva, Switzerland: WHO
- Nigussie M, Hagos G, Alemayhu M et al. Pulmonary Tuberculosis Mimicking a Lung Cancer: a Case Series. Ethiop Med J 62 (1) 73 -77.
- Chai Q, Lu Z, Liu Z, Zhong Y, Zhang F, Qiu C, Li B, Wang J, Zhang L, Pang Y, Liu CH. Lung gene expression signatures suggest pathogenic links and molecular markers for pulmonary tuberculosis, adenocarcinoma and sarcoidosis. Communications biology. 2020 Oct 23;3(1):604.
- Parveen NS, Khan B. Tuberculosis Mimicking As Lung Cancer. Sch J Med Case Rep. 2023 Apr 11;4:444-7.
- Fijołek J, Wiatr E, Polubiec-Kownacka M, Blasińska-Przerwa K, Szolkowska M, Szczepulska-Wojcik E, Roszkowski-Sliz K. Pulmonary tuberculosis mimicking lung cancer progression after 10 years of cancer remission. Advances in Respiratory Medicine. 2018 Apr;86(2):92-6.
- Yi Wu C, Yun Hu H, Yun Pu C, Huang N, Che Shen H, Pin Li C et al. Pulmonary Tuberculosis Increases the Risk of Lung Cancer. 2011 February;117:618–24.
- Sun W, Zhang L, Liang J, Li X, Yang Y, Sun W, Hou J. Comparison of clinical and imaging features between pulmonary tuberculosis complicated with lung cancer and simple pulmonary tuberculosis: a systematic review and meta-analysis. Epidemiology & Infection. 2022 Jan;150:e43.
- Parker CS, Siracuse CG, Litle VR. Identifying lung cancer in patients with active pulmonary tuberculosis. Journal of Thoracic Disease. 2018 Oct;10(Suppl 28):S3392.
- Khan D, Danjuma M, Saddique MU, Murshed KA, Yassin MA. Adenocarcinoma of the lung mimicking miliary tuberculosis. Case Reports in Oncology. 2020 May 5;13(1):139-44.
- Morikawa K, Misumi S, Fukuda T. A case of pulmonary tuberculosis with multiple nodules mimicking lung metastases. BJR case reports. 2019 Sep 1;5(3):20180124.
- Xiang Y, Huang C, He Y, Zhang Q. Cancer or tuberculosis: a comprehensive review of the clinical and imaging features in diagnosis of the confusing mass. Frontiers in Oncology. 2021 Apr 28;11:644150.
Corresponding Author
Dr Shruti Thakur
Assistant Professor, Department of Radiodiagnosis, IGMC, Shimla, Zip code 171001
DOI: https://dx.doi.org/10.18535/jmscr/v12i05.03
