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Case Reports: Reminder of important clinical lesson
Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult
  1. Peng Yun Ng1,
  2. Mustafa Kadam2 and
  3. Craig Batista1
  1. 1Respiratory Medicine, Guy's and St Thomas' Hospitals NHS Trust, London, UK
  2. 2Acute Internal Medicine, Guy's and St Thomas' Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Peng Yun Ng; pengyunng{at}gmail.com

Abstract

A healthy, immunocompetent South Asian man in his mid-20s, with a medical history of gastric ulcer, presented to Accident & Emergency with pleuritic chest pain, shortness of breath, fever, night sweats, weight loss, dry cough and asymptomatic iron deficiency anaemia. Following his initial assessment and investigations (chest X-ray, CT and blood tests), a diagnosis of miliary tuberculosis (TB) was made and empirical antimicrobial treatment started. However, subsequent microbiological testing, including urine, blood, induced sputum and lymph node sampling, was negative. Being interpreted as non-diagnostic, the antimicrobial therapy was continued. Following a clinical deterioration while on treatment, the patient’s case was re-evaluated and further investigations, including a repeat CT and a liver biopsy, confirmed a diagnosis of stage IV (T1aN3bM1) gastric carcinoma. Our case highlights the diagnostic challenges in differentiating metastatic cancer from miliary TB. We also focus on possible cognitive biases that may have influenced the initial management decisions.

  • Respiratory system
  • TB and other respiratory infections
  • Gastric cancer

https://doi.org/10.1136/bcr-2022-249880

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    Footnotes

    • Contributors PYN wrote the summary, background, case presentation, investigations, treatment, discussion, reference and conclusion of the case report. PYN is the guarantor of the case report. MK edited the manuscript, supplied supplementary images, facilitated the postmortem discussion of case with peers and final review of the manuscript. CB edited and reviewed the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.