Background: Tuberculosis (TB) is a very common and easily diagnosed as a malignancy. However, studies have described the difference between TB and lung cancer. Single-organ TB and lung cancer are often easily distinguished clinically. Atypical systemic hematogenous disseminated TB (HDTB) is uncommon, including rare cases involving multiple organs such as cervical lymph nodes, pleura, liver, and lung TB simultaneously, which are more confusing and easily misdiagnosed in clinical practice.
Case Presentation: A HIV-negative 56-year-old male was hospitalized for chest disease with main symptoms of chest tightness, chest pain, fatigue, anorexia, and weight loss. Heart rate 109 times/min, the computed tomography (CT) scans of the neck, chest, and abdomen revealed multiple nodules in the right pleura, right pleural encapsulated effusion, and limited, incomplete expansion of the middle and lower lobes of the right lung, enlarged lymph nodes in the right hilar and mediastinal and diaphragm groups, and multiple slightly low-density nodules in the liver, bone destruction in the 2nd thoracic vertebra, raising the possibility of multiple liver metastases of right lung cancer and malignant pleural fluid. The lymph nodes in the neck, mediastinum, abdomen, and pelvis were enlarged bilaterally. After comprehensive analysis, the patient was diagnosed with atypical systemic HDTB. After three months of conventional anti-TB treatment, the patient refused our hospital follow-up, and his symptoms improved significantly during the telephone follow-up.
Conclusion: Most previous TB misdiagnoses involved a single organ, and this case enriches the clinical experience of diagnosing atypical HDTB. We encourage clinicians to establish a dynamic diagnostic and therapeutic mindset, emphasizing the value of biopsy and pathology.



中文翻译：

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多器官结核误诊为肺癌一例并文献复习

背景：结核病（TB）是一种非常常见且容易诊断的恶性肿瘤。然而，研究已经描述了结核病和肺癌之间的区别。单器官结核和肺癌在临床上通常很容易区分。非典型全身性血行播散性结核病（HDTB）并不常见，包括同时累及颈淋巴结、胸膜、肝、肺等多个器官的罕见病例，临床上较易混淆且易误诊。
病例介绍：一名HIV阴性的56岁男性因胸部疾病入院，主要症状为胸闷、胸痛、乏力、厌食、体重减轻。心率109次/分，颈部、胸部、腹部CT扫描显示右侧胸膜多发结节，右侧胸膜有包裹性积液，右肺中下叶扩张有限、不完全右肺门及纵隔、膈肌群淋巴结肿大，肝脏多发稍低密度结节，第2胸椎骨质破坏，增加右肺癌多发肝转移及恶性胸水的可能性。双侧颈部、纵隔、腹部、骨盆淋巴结肿大。经综合分析，患者诊断为非典型全身性HDTB。经过三个月的常规抗结核治疗后，患者拒绝我院随访，电话随访期间症状明显好转。
结论：既往结核病误诊大多涉及单一器官，本病例丰富了诊断非典型HDTB的临床经验。我们鼓励临床医生建立动态的诊断和治疗心态，强调活检和病理学的价值。