ATYPICAL PRESENTATION OF PULMONARY TUBERCULOSIS

Abstract

Tuberculosis may have wide range of clinical presentation. Here, we present one of atypical presentation of pulmonary tuberculosis. A 41 years male presented to Medical OPD of Chitwan Medical College & Teaching Hospital, tertiary level hospital located in central Terai region of Nepal with chief complaints of generalized body swelling for 4 days and failure to pass urine for 10 hours. Clinical findings revealed pulse 80 bpm, BP 110/70 mmHg and gross edema present all over body. On investigation, his urine examination showed protein +, pus cells plenty and serum albumin 1.4 gm/dl. So, initial diagnosis of Nephrotic syndrome and Urinary Tract Infection was made. 24 hour urinary protein was sent which didn’t suggest Nephrotic syndrome. Patient was treated initially with antibiotics for UTI, potassium supplement and diuretics. In addition, he developed fever on 3rd day of admission which did not subside even after 5 days of antibiotic therapy. His chest examination revealed crackles bilaterally on infraclavicular and subscapular regions. Initially chest X-ray and later on CECT chest were done which showed multiple enlarged intrathoracic lymph nodes. His initial clinical examination had not revealed any enlarged peripheral lymph nodes but after doing CECT, retrospective clinical examination revealed enlarged right supraclavicular lymph nodes, FNAC of which suggested tubercular lymphadenopathy. Anti-Tubercular Therapy was started on 2023/01/25 and after 5 days of treatment his fever subsided, appetite and general health being also improved. So, generalized intrathoracic lymphadenopathy can be atypical presenting feature of tuberculosis which is generally confused with malignancy and sarcoidosis.