The mask of acute bacterial pneumonia may disguise the face of tuberculosis.

INTRODUCTION: Pulmonary tuberculosis (TB) can present as acute pneumonia. Differentiation of tuberculous from non-tuberculous community-acquired pneumonia (CAP) is an important challenge in endemic areas. The purpose of this study was the comparison between characteristics of tuberculous and non-tuberculous CAP patients. METHODS: In this prospective and observational study, all adult patients (aged ≥16 years) who were admitted to Imam Reza Hospital in Mashhad (Iran) with the diagnosis of CAP, between February 2013 and January 2014, were enrolled. Clinical, radiological, and microbiological data of the patients were collected and reviewed. Statistical analyses were performed using SPSS 14 software and R programming language. RESULTS: We studied 120 patients with diagnosis of acute CAP including 21 (17.5%) tuberculous and 99 (82.5%) non-tuberculous CAP. The etiologies of CAP in the latter group were as follow: S. pneumoniae 29 (29.3%), followed by S. aureus, polymicrobial including anaerobes, and other agents. The diagnosis of pneumonia remained unknown in 49 (40%) patients. We found approximately equal gender distribution among two study groups (14/21 vs. 61/99, 63.6% vs. 62.9%, p=0.948). Fifty percent of patients with tuberculous CAP had opioid addiction that was more frequent compared with non-tuberculous group (p=0.240). 52.4%, 63.2%, 30%, and 90% of patients with tuberculous CAP had severe presentation based on PSI, IDSA/ATS, CURB-65, and SMART-COP, respectively. CONCLUSIONS: The diagnosis of TB should be considered in all patients who presented with CAP in endemic regions. It could not be differentiated from other causes of pneumonia on clinical and radiological grounds.

A Healthy Young Woman with Acute Respiratory Distress Syndrome: an unfamiliar face of a familiar disease.

The presented case features a rare manifestation of pulmonary tuberculosis in a previously healthy young woman who had acute presentation of tuberculous pneumonia complicated by acute respiratory distress syndrome. In developing countries, mycobacterium tuberculosis is an important cause of community-acquired pneumonia (CAP). TB can present as an acute process and should be included in the differential diagnosis of CAP. This case is special in its manifestation from several clinical perspectives, including the lack of an underlying medical condition or immune defect and the development of acute respiratory distress syndrome (ARDS) in non-miliary and non-disseminated tuberculosis. In conclusion, the diagnosis of TB should be considered in all patients who present with CAP in endemic regions.

A 28-Year-Old Woman with Fever, Weight Loss, Pancytopenia, and Multiple Hepatosplenic and Bone Lesions.

Brucellosis is a systemic zoonotic infection that can involve any organ or system in the body. It may present with a broad spectrum of clinical manifestations. Considering such myriad presentations, brucellosis should always be considered in the differential diagnosis of any febrile illness in a compatible epidemiological context. Here, we report a rare presentation of acute brucellosis with multifocal osteomyelitis and hepatosplenic lesions.