We present a case of pulmonary tuberculosis (PTB) in a 38-year-old male smoker and alcoholic with an atypical and varied presentation. The patient was a daily wage worker who exhibited symptoms of dry cough and dyspnea but lacked the classic features of fever, weight loss, chest pain, and hemoptysis. Chest X-ray revealed non-homogeneous opacities and multiple small cavities in both lungs, initially raising suspicion for community-acquired pneumonia, atypical pneumonia, or polyangiitis. Acid-fast bacilli (AFB) testing and then line probe assay (LPA) ultimately confirmed the diagnosis of Mycobacterium tuberculosis (Mtb), which is sensitive to isoniazid and rifampicin. This case highlights the variable nature of presentation in tuberculosis (TB), the importance of maintaining a broad differential diagnosis even in the absence of typical symptoms, and the importance of microbiological diagnosis for accurate diagnosis. Risk factors of tuberculosis like smoking and alcoholism, should be considered along with the screening of common comorbidities like diabetes.
Key words: atypical presentation; pulmonary tuberculosis; smoking; alcoholism; diabetes, line probe assay.
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