Disseminated Tuberculosis Mimicking Lung Cancer with Multiple Bone Metastasis: A Case Report

Laksmi Wulandari, Putri Mega Juwita

= http://dx.doi.org/10.20473/ijtid.v8i3.17961
Abstract views = 395 times | downloads = 273 times


Tuberculosis (TB) is a contagious infectious disease caused by Mycobacterium tuberculosis (Mtb) of which attacking various organs particularly the lungs. Tuberculosis can occur together with malignancy or manifest as malignancy. Lung tuberculosis may appear in a variety of clinical and radiological manifestations caused by other diseases including tumors. These tumors are called pseudo-tumors. TB pseudo-tumor is a rare manifestation that can occur in immunocompetent patients in both primary and post-primary TB. The clinical presentation of TB pseudo-tumor is nonspecific and the clinical suspicion must be increased to diagnose related diseases. Radiological features can also be challenging to be distinguished from actual tumors. The classic manifestations of pulmonary TB are generally easy to diagnose due to the distinctive clinical and radiological characteristics nonetheless some pulmonary TB symptoms are also often found in patients with lung cancer. Infection patients resemble malignancies most were asymptomatic (> 27%) and the remaining 27% showed symptoms that varied with the average symptoms experienced about 1 month earlier. Clinical presentations that require a lot of misdiagnosis result in delayed treatment and unnecessary procedures. Establishing a diagnosis in cases of tuberculosis that causes malignancy is very important since the management and outcomes of the infection and malignancy process are quite different. Consequently we report a 24-year-old man with tuberculosis possible lung cancer with multiple bone metastase. Extrapulmonary tuberculosis which attacks bones and joints constitutes 10% to 20% of all TB cases. The location of bone and joint TB generally develops in the lumbar or thoracic vertebrae


tuberculosis, pseudo-tumour, lung cancer, bone metastasis, extrapulmonary tuberculosis.

Full Text:



PUSDATIN. Info Datin Kemenkes RI - Tuberkulosis: Temukan Obati sampai Sembuh [Internet]. 2015;7. Available from: http://www.depkes.go.id/download.php?file=download/pusdatin/infodatin/infodatin_tb.pdf

World Health Organization. Global Tuberculosis Report. 2018.

World Health Organization. Nutritional Care and Support. 2013.

Lang S, Sun J, Wang X, et al. Asymptomatic pulmonary tuberculosis mimicking lung cancer on imaging: A retrospective study. Exp Ther Med 2017;14(3):2180–2188.

Androulaki A, Papathomas TG, Liapis G, et al. Inflammatory pseudotumor associated with Mycobacterium tuberculosis infection. Int J Infect Dis 2008;12(6):607–610.

Crevel, Reinout; Ottenhoff, Tom H.M.; van der Meer JWM. Innate Immunity to Mycobacterium tuberculosis. Society 2005;15(2):294–309.

Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan KKRI. Pedoman Nasional Pengendalian Tuberkulosis. 2011.

Cantres-fonseca OJ, Rodriguez-cintrón W, Olmo-arroyo F Del, Baez-corujo S. Extra Pulmonary Tuberculosis : An Overview. In: Chauhan NS, editor. Role of Microbes in Human Health and Diseases. 2019. p. 1–16.

I. Rolston, Saul Rodriguez, N. D K V. Pulmonary infections mimicking cancer: a retrospective, three-year review. Support Care Cancer 1997;5(2):90–93.

Gállego Pérez-Larraya J, Hildebrand J. Brain metastases. Handb Clin Neurol 2014;121:1143–1157.

Go SW, Lee HY, Lim CH, et al. Atypical disseminated skeletal tuberculosis mimicking metastasis on PET-CT and MRI. Intern Med 2012;51(20):2961–2965.

Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 67. Penanggulangan Tuberkulosis. Dinas Kesehat 2017;163.

Hong L, Wu JG, Ding JG, et al. Multifocal skeletal tuberculosis: Experience in diagnosis and treatment. Med Mal Infect 2010;40(1):6–11.

Pang Y, An J, Shu W, et al. Epidemiology of extrapulmonary tuberculosis among inpatients, China, 2008-2017. Emerg Infect Dis 2019;25(3):457–464.

Solovic I, Jonsson J, Korzeniewska-Kosela M, et al. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. Eurosurveillance 2013;18(12):1–9.

Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am 2001;39(2):329–342.

Sakuraba M, Sagara Y, Komatsu H. Surgical treatment of tuberculous abscess in the chest wall. Ann Thorac Surg 2005;79(3):964–967.

Reedy, Ravikanth; Sunil, Mathew; Selvam RP. Calvarial Tuberculosis Presenting as Multiple Osteolytic Soft Tissue Lessions. CHRISMED J Heal Res 2014;1(2):2–4.

Raut AA, Nagar AM, Muzumdar D, et al. Imaging Features of Calvarial Tuberculosis: A Study of 42 Cases. Am J Neuroradiol 2004;25(3):409–414.

Garg RK, Somvanshi DS. Spinal tuberculosis: A review. J Spinal Cord Med 2011;34(5):440–454.

Cormican L, Hammal R, Messenger J, Milburn HJ. Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J 2006;82(963):46–51.

Holeppagol KB, Nayak BN, Goyal RKK, Kumar AK, Sahoo PK, Biswal D. Neglected Recurrent Scalp Sinus: Calvarial Tuberculosis with Intracranial and Extracranial Extension. World Neurosurg [Internet] 2017;98:879.e5-879.e7. Available from: http://dx.doi.org/10.1016/j.wneu.2016.11.065

Radiologist C, Hospital GT. Calvarial tuberculosis features in 3 cases. West Engl Med J 2013;112(1):2–4.

Agrawal V, Patgaonkar PR, Nagariya SP. Tuberculosis of spine. J Craniovertebr Junction Spine 2010;1(2):74–85.


  • There are currently no refbacks.

Copyright (c) 2020 Indonesian Journal of Tropical and Infectious Disease

View My Stats

IJTID Indexed by : 


IJTID (pISSN 2085-1103eISSN 2356-0991is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Lembaga Penyakit Tropis (Institute of Tropical Disease)

Universitas Airlangga

Kampus C Mulyorejo

Surabaya 60115