Pulmonary tuberculosis presenting as atypical pneumonia syndrome

ABSTRACT

A case of dessimanted pulmonary tuberculosis in a 30 year old Somali male who presented with fever, cough, weight loss over a period of one month, is reported because of its unusual presentation. On examination the patient looked ill, dyspnoeic, pale and on auscultation of the chest there were late inspiratory crackles. Repeated sputum samples were negative for acid-fast bacilli. Chest x-ray showed bilateral micronodular infiltration. All other investigations were negative apart from Legionella titre. Initially he was treated as a case of atypical pneumonia with erythromycin but did not show improvement. Lung biopsy was carried out for diagnostic reasons and this confirmed the presence of pulmonary tuberculosis. Clinical and radiological improvement started after instituting anti-tuberculosis treatment