Pulmonary pseudotumoral tuberculosis in an old man: A rare presentation

Abstract

The pseudotumoral form of tuberculosis is very rare in healthy immunocompetent subjects and can simulates lung carcinoma causing diagnosis dilemma or lead to abusive surgical resection. Here we report a case of pulmonary tuberculosis in its pseudotumoral form in an immunocompetent old men who presented with cough, fatigue and fever. A computerized tomography of the chest indicated a dishomogeneous mass that compressed and deformed the left main bronchus that was referable to a primary tumor. The hystopatological exam from the bioptic samples obtained by bronchoscopy was negative for neoplasia. Moreover, an abdomen CT scan showed hypodense solid lesions of the liver likely to be considered as metastasis; the histological analysis of these hepatic lesions was negative for neoplasia. It was necessary to perform a second CT scan of the chest and another bronchoscopy with biopsy and histopathological examination before establishing the diagnosis of the pulmonary pseudotumoral form. The case report confirm, as previously described, the difficulties in the diagnosis of this rare form of tuberculosis that lead to a delay in therapy, and suggest that the pseudotumor has to be included as different diagnosis of pulmonary mass also in healthy immunocompetent subjects.