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Tuberculosis or not tuberculosis: Attente cogitanti
*For correspondence: agarwal.ritesh@outlook.in
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Received: ,
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This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
A 40 yr old male† presented to the Chest Clinic, department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India, in December 2015, with fever, cough, and anorexia for the past 20 days. Chest radiograph revealed mediastinal widening. Positron-emission tomography-computed tomography (PET-CT) scan confirmed the presence of enlarged mediastinal lymph nodes, which were intensely fluorodeoxyglucose (FDG) avid (Figure). Interestingly, on the maximum intensity projection image, the tuberculin skin test site showed intense FDG uptake (Figure), thereby suggesting the aetiology to be tuberculosis. Endobronchial ultrasound-guided transbronchial aspiration from the mediastinal nodes showed necrotic granuloma. Mycobacterium tuberculosis was detected using Xpert MTB/RIF from the lymph node aspirate. Treatment with standard anti-tubercular therapy resulted in a clinical and radiological resolution. At six months' follow up, a CT chest was normal.
- Maximum intensity projection image of the positron-emission tomography scan showing the presence of fluorodeoxyglucose-avid mediastinal lymph nodes (white arrow) and tuberculin skin test site (black arrowhead).
In clinical medicine, there are several instances where a closer scrutiny can suggest a diagnosis, such as PET-CT in this instance.
