Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult.
BMJ Case Rep
; 15(5)2022 May 24.
Article
in English
| MEDLINE | ID: covidwho-1865145
ABSTRACT
A healthy, immunocompetent South Asian man in his mid-20s, with a medical history of gastric ulcer, presented to Accident & Emergency with pleuritic chest pain, shortness of breath, fever, night sweats, weight loss, dry cough and asymptomatic iron deficiency anaemia. Following his initial assessment and investigations (chest X-ray, CT and blood tests), a diagnosis of miliary tuberculosis (TB) was made and empirical antimicrobial treatment started. However, subsequent microbiological testing, including urine, blood, induced sputum and lymph node sampling, was negative. Being interpreted as non-diagnostic, the antimicrobial therapy was continued. Following a clinical deterioration while on treatment, the patient's case was re-evaluated and further investigations, including a repeat CT and a liver biopsy, confirmed a diagnosis of stage IV (T1aN3bM1) gastric carcinoma. Our case highlights the diagnostic challenges in differentiating metastatic cancer from miliary TB. We also focus on possible cognitive biases that may have influenced the initial management decisions.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Tuberculosis, Miliary
/
Neoplasms
Type of study:
Case report
/
Diagnostic study
/
Experimental Studies
/
Prognostic study
Limits:
Adult
/
Humans
/
Male
/
Young adult
Language:
English
Year:
2022
Document Type:
Article
Affiliation country:
Bcr-2022-249880
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