CASE
REPORT
Beyond the Obvious: Unveiling the Diagnosis
When Symptoms Mislead
Vlad-Alexandru
IONESCU1,2, Alin-Bogdan DEACANU3, Crista-Loredana TIUCA1,2,
Anda-Maria BENTIA2, Alexandra BEJAN2, Elena-Roxana
BEJENARIU2,
Andreea Alina BELCHITA2, Marian-Alexandru BELCHITA2,
Irina-Mihaela BELU2,
Bianca BERGHILA2, Gina GHEORGHE1,2, Camelia Cristina
DIACONU1,2,4
1Department of Internal Medicine, Clinical Emergency Hospital of
Bucharest, Bucharest, Romania
2„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3 Rheumatology Department, Colentina Clinical Hospital of Bucharest
4 Academy of Romanian Scientists
DOI 10.56082/annalsarscimed.2024.2.65
Correspondence:
Gina Gheorghe, Department of Internal Medicine, Clinical
Emergency Hospital of Bucharest, Bucharest, Romania; e-mail: gina.gheorghe@drd.umfcd.ro
Abstract. Persistent inflammatory syndrome
is a frequently encountered and challenging condition in internal medicine. In
cases when a definitive diagnosis is not established, this disease necessitates
a thorough diagnostic approach to rule out infections, autoimmune disorders,
and cancers.
Case presentation: We present the case of an
asymptomatic patient hospitalized with a significant inflammatory syndrome, in
whom initial infection screening failed to reveal any diagnosis that might
account for the biological abnormalities. In the lack of a diagnosis and
the persistence of the inflammatory condition despite broad-spectrum antibiotic
therapy, computed tomography examination of the chest, abdomen, and pelvis with
contrast substance was performed, which identified a lung lesion with malignant
features. The diagnostic management continued by bronchoscopy, bronchoalveolar
lavage, and cytological, bacteriological, and molecular examinations, which
revealed the presence of Mycobacterium tuberculosis.
Conclusions: This case contributes to the
understanding of tuberculosis as an “oncologic mimic” in cases of unexplained
prolonged inflammatory syndrome, underscor the value of rigorous diagnostic
approaches in atypical presentations and emphasizing the diagnostic vigilance
required in patients with risk factors for this infectious disease.
Keywords: persistent inflammatory syndrome, tuberculosis,
diagnosis, oncological mimic
