Pulmonary tuberculosis masquerading as community acquired pneumonia

Pulmonary tuberculosis usually has a smouldering onset and progression, and patients typically present with the symptoms of cough, weight loss, anorexia, night sweats and malaise that is usually present for a few weeks before presentation.

A 22-year old man presented with symptoms, signs and radiological features of an acute severe community acquired pneumonia(CAP), a presentation that can delay the diagnosis of TB, and cause institution of antibiotics that may transiently cause clinical improvement, only to be followed by deterioration. We discuss the features that should make a physician suspect that possibility of TB, and illustrate how in a high-burden country, even in the absence of these features, TB must be considered in the differential diagnosis of any patient presenting with a CAP.