More Than Meets the Scan in Diagnosing Disseminated Tuberculosis (TB)
Document Type
Conference Proceeding
Publication Date
2025
Publication Title
American Journal of Respiratory and Critical Care Medicine
Abstract
Background:Disseminated tuberculosis (TB) represents a diagnostic challenge, particularly in non-endemic regions where clinical suspicion may be lower. We present a case of culture-confirmed disseminated tuberculosis with initially negative screening tests, emphasizing the importance of comprehensive diagnostic approaches in high-risk populations.
Case Presentation:A 37-year-old immigrant man presented with progressive dyspnea, productive cough, and abdominal distention over two weeks. Notable findings included hypoxia requiring supplemental oxygen (SpO2 88% on room air), bilateral decreased breath sounds, and significant unintentional weight loss of 10-15 pounds. Further investigation with a chest computed tomography (CT) was obtained, unveiling moderate non-loculated bilateral pleural effusions, scattered pulmonary nodules, and extensive lymphadenopathy, raising concern for malignancy. Serum testing was notable for elevated adenosine deaminase, but negative tumor markers(β-HCG, AFP, LDH). Given his history of immigration from an endemic region, an initial serum QuantiFERON-TB Gold and acid-fast bacilli (AFB) smear was sent which yielded negative results. Furthermore, a diagnostic thoracentesis was pursued, revealing lymphocytic predominant (>70%) exudative effusion with marginally elevated adenosine deaminase. Diagnostic bronchoscopy with endobronchial ultrasound-guided and Transbronchial needle aspiration/FNA was done off lymph node station 11R, which was sent for cytology, cultures, and flow cytometry, which revealed acid-fast bacilli and necrotizing granulomas, confirming the diagnosis. Upon further questioning regarding the potential exposure to TB, he recalled being treated for TB in childhood but did not complete the prescribed treatment. The patient commenced the anti-tuberculous regimen, including rifampicin, isoniazid, pyrazinamide, and ethambutol. Clinical improvement was observed within two weeks of treatment initiation.
Discussion:This case highlights the importance of maintaining a high index of suspicion for disseminated TB in patients from endemic regions who present with multi-system involvement. A thorough migration history and assessment of prior treatment exposure are essential for accurate risk stratification. Given the often low diagnostic yield of initial screening tests in disseminated TB, further investigation through invasive methods, such as EBUS-TBNA, was crucial to achieving a definitive diagnosis when conventional tests return negative results.
Volume
211
First Page
A2366
Recommended Citation
Alnabulsi Z, Faizee F, Mina N. More than meets the scan in diagnosing disseminated tuberculosis (tb). Am J Respir Crit Care Med. 2025;211:A2366. doi: 10.1164/ajrccm.2025.211.Abstracts.A2366
DOI
10.1164/ajrccm.2025.211.Abstracts.A2366
Comments
The American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA.