When the Diagnosis is a Victim of the Circumstances

INTRODUCTION: Haemoptysis is a common symptom which can sometimes mimic gastrointestinal bleeding. CASE DESCRIPTION: We describe the case of a 31-year-old man who presented to the emergency department after an episode of sudden nausea and presumed massive haematemesis. The situation was interpreted as gastrointestinal bleeding but clinical evolution and greater attention to the anamnesis resulted in a diagnosis of pulmonary tuberculosis and the provision of appropriate care. DISCUSSION: This report emphasizes the difficulty of differentiating between haemoptysis and haematemesis and the importance of a careful anamnesis and attention to all clinical circumstances for an accurate diagnosis. LEARNING POINTS: Haematemesis and haemoptysis are not always distinguished from each other when a patient’s history is being collected. Despite being a rare manifestation of tuberculosis, in the correct epidemiological context, haemoptysis should raise the suspicion of pulmonary tuberculosis. The clinical setting and the need for immediate care should not limit clinical investigation or the differential diagnosis.