Pseudo-tumoral pulmonary tuberculosis in immunocompetent adult

Abstract

Introduction: The pseudo-tumoral form of tuberculosis is exceptional, it accounts for only 1 to 5% of the pulmonary tuberculosis. Because it simulates lung carcinoma, diagnosis can be delayed and lead to abusive surgical resection. Observation: a 23-year-old Tunisian immunocompetent adult without pathological history was explored for trailing fever, cough and thoracic pains which did not improved by the symptomatic treatment. The somatic examination found a feverish patient with 38.5 °C. Biology revealed a marked inflammatory syndrome. Chest x-ray showed a round parenchymal masse of the right upper lobe. The patient was treated like a bacterial pneumonitis but without improvement. Lung CT scan objectified a well limited parenchymal masse occupying the entire right upper lobe with annular catch of contrast. Tumor makers were normal. Bronchoscopic examination was normal without neoplastic cells on the aspiration. Direct exam for mycobacterium tuberculosis was negative. Transbronchial lung biopsy showed granulomas with caseation and Langhans giant cells. Under anti-tubercular therapy the evolution was favorable with the disappearance of the functional complaints and sub-total radiological cleaning at the end of a few weeks. Conclusion: This particular form of pulmonary tuberculosis deserves to be known especially in a country as ours where tuberculosis remains frequent.