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Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult
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 assess...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131068/ https://www.ncbi.nlm.nih.gov/pubmed/35609937 http://dx.doi.org/10.1136/bcr-2022-249880 |
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author | Ng, Peng Yun Kadam, Mustafa Batista, Craig |
author_facet | Ng, Peng Yun Kadam, Mustafa Batista, Craig |
author_sort | Ng, Peng Yun |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9131068 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-91310682022-06-09 Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult Ng, Peng Yun Kadam, Mustafa Batista, Craig BMJ Case Rep Case Reports: Reminder of important clinical lesson 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. BMJ Publishing Group 2022-05-23 /pmc/articles/PMC9131068/ /pubmed/35609937 http://dx.doi.org/10.1136/bcr-2022-249880 Text en © BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ. |
spellingShingle | Case Reports: Reminder of important clinical lesson Ng, Peng Yun Kadam, Mustafa Batista, Craig Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult |
title | Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult |
title_full | Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult |
title_fullStr | Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult |
title_full_unstemmed | Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult |
title_short | Metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult |
title_sort | metastatic cancer masquerading as miliary tuberculosis in an immunocompetent young adult |
topic | Case Reports: Reminder of important clinical lesson |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131068/ https://www.ncbi.nlm.nih.gov/pubmed/35609937 http://dx.doi.org/10.1136/bcr-2022-249880 |
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