ATYPICAL PRESENTATIONS OF PULMONARY TUBERCULOSIS: CASE SERIES AND REVIEW OF LITERATURE

TYPE: Abstract Publication TOPIC: Signs and Symptoms of Chest Diseases PURPOSE: To describe atypical presentations of Pulmonary tuberculosis METHODS: Case 1-A 32 year old diabetic female presented with 4 weeks history of low grade fever, dry cough and loss of appetite. Chest x ray and CT thorax revealed a rounded lesion suggestive of round pneumonia. Bronchoscopic lavage CB NAAT revealed mycobacterium tuberculosis while fungal and bacterial cultures revealed no growth. CT guided biopsy revealed granulomatous inflammatory disease. Case 2-A 50 year old non-smoker female presented with history of frank haemoptysis over past 5 days along with right chest pain. A CXR showed bilateral lower zone haziness while bronchoscopy revealed nodular growths in Right upper lobe bronchus with infiltration from where biopsy and aspirate was taken and subjected to analysis. CB NAAT of BAL fluid demonstrated Mycobacterium tuberculosis while brush, bronchial wash and endobronchial biopsy showed no atypical/malignant cells. Both patients were started on 4 drug antitubercular treatment. RESULTS: Tuberculosis is a great mimicker. Round pneumonia usually is associated with bacterial infections and streptococcus pneumonia and mycoplasma pneumonia are both commonly reported etiologies. Pulmonary tuberculosis presenting as round pneumonia is a rare diagnosis. In second case patient presented as endobronchial masses and infiltration. Tuberculosis presenting as endobronchial mass is an uncommonly reported entity. CONCLUSIONS: Tuberculosis should be part of differential diagnosis even in presence of atypical radiology or endobronchial appearance. Clinicians should be aware of these atypical presentations to avoid misdiagnosis as well as erroneous treatment and unnecessary delay. CLINICAL IMPLICATIONS: Clinicians should be aware of atypical presentations of pulmonary tuberculosis to avoid misdiagnosis and delays in treatment initiation. DISCLOSURE: No significant relationships. KEYWORD: Atypical presentation, round pneumonia, endobronchial mass