Pulmonary tuberculosis in an immunocompetent host with atypical radiographic findings

Background: Pulmonary tuberculosis (TB) is generally thought of as a disease seen in recent immigrants from endemic regions of the world or in those with chronic debilitating conditions causing significant immunosuppression. However, there is a sub-segment of the population, who are otherwise healthy, lack risk factors for TB and present with mild, protean symptoms, where a high index of suspicion for TB, requiring a thorough work up is warranted.
Case Report: The following case describes an atypical clinical presentation of pulmonary TB in an otherwise healthy, foreign born young man. Chest radiography demonstrated impressive bilateral granulomatous appearing infi ltrates and consolidations, which evoked a wide differential diagnosis. Initial work up, including PPD testing and sputum AFB were negative. Bronchoscopy was performed and after 30 days of incubation the bronchial washing culture specimen turned positive for AFB. DNA probe testing confirmed the specimen to be M. tuberculosis and appropriate treatment was instituted .
Conclusions: Atypical presentations of pulmonary TB in young, healthy, immunocompetent foreign born individuals exist. These cases can be challenging as a high index of suspicion for TB is required in the setting of mild symptomotology and atypical radiographic fi ndings. Often invasive diagnostic testing, including bronchoscopy may be needed to confi rm a diagnosis so that appropriate medical treatment can be instituted and measures taken to prevent further spread of a potentially fatal disease.

Keywords: Tuberculosis, pulmonary, immunocompetent