[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-457204-105":59,"doc-detail-457204-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","distinguishing-tuberculosis-from-malignancy-when-multisystem-involvement-occurs-a-case-description","Distinguishing tuberculosis from malignancy when multisystem involvement occurs - a case description","","Letter to the Editor presenting a diagnostic challenge in a 43-year-old male with lymphadenopathy, bone lesions, and pulmonary nodules. TB and malignant disease showed overlapping clinical and radiological features, leading multiple hospitals to initially suspect metastatic malignancy based on CT, elevated CRP, and high FDG uptake on PET-CT. Subsequent tissue sampling revealed granulomatous inflammation in one setting and M. tuberculosis nucleic acid positivity in another, while TB stains and PCR were discordant across specimens, ultimately clarifying the diagnosis and guiding management decisions.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/distinguishing-tuberculosis-from-malignancy-when-multisystem-involvement-occurs-a-case-description/457204/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/distinguishing-tuberculosis-from-malignancy-when-multisystem-involvement-occurs-a-case-description/457204.png","ImageObject",300,407,{"name":92,"@type":93},"นรินทร์","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why can tuberculosis be mistaken for malignancy in multisystem involvement?","Question",{"text":113,"@type":114},"TB can disseminate beyond the lungs and produce clinical and radiological findings that resemble metastatic malignant disease, including similar imaging characteristics and lymphadenopathy.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What initial findings led clinicians to suspect metastatic malignancy?",{"text":118,"@type":114},"Chest CT suggested malignancy with mediastinal or hilar lymphadenopathy and destructive bone lesions, accompanied by markedly elevated CRP and later high FDG uptake on PET-CT.",{"name":120,"@type":111,"acceptedAnswer":121},"How was tuberculosis confirmed despite some negative TB tests?",{"text":122,"@type":114},"Molecular testing identified M. tuberculosis nucleic acid in a left iliac bone biopsy, while TB-specific stains and PCR results varied among different biopsy sites, highlighting specimen-dependent discordance.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},457204,1790791300,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},2336475104957,"https://ap-avatar.wpscdn.com/avatar/22000c4c6bd8a5076e1?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787554080175789136","Letter to the Editor  \nDistinguishing tuberculosis from malignancy when multisystem involvement occurs: a case description  \nXiuming Wang^, Lei Zhang, Yue Liu, Jing Zhao, Zhiyong Bai, Huabin Zhang  \nDepartment of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China  \nCorrespondence to: Huabin Zhang, MD; Zhiyong Bai, MD. Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, 168 Litang Road, Beijing 102218, China. Email: [zhba00584@btch.edu.cn](zhba00584@btch.edu.cn); [bzya00809@btch.edu.cn](bzya00809@btch.edu.cn).  \nSubmitted Jun 25, 2025. Accepted for publication Nov 03, 2025. Published online Dec 31, 2025.  \ndoi: 10.21037/qims-2025-1442  \nView this article at: [https://dx.doi.org/10.21037/qims-2025-1442](https://dx.doi.org/10.21037/qims-2025-1442)  \nIntroduction  \nTuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis, continues to pose a substantial global health challenge. Despite the significant advancements made in diagnostic methods and therapeutic interventions, TB remains a leading cause of morbidity and mortality worldwide. The disease’s diverse manifestations, especially in individuals with compromised immune systems or coinfections, can closely mimic those of malignant diseases, leading to diagnostic confusion that pose challenges even for the most experienced clinicians (1) .  \nThe lungs serve as the principal site of TB infection. However, the disease can also disseminate hematogenously, involving various organs, including the bones and lymph nodes (2) . This extrapulmonary involvement complicates the clinical presentation, as it shares clinical and radiological characteristics similar to those of metastatic malignancies (2) . Distinguishing between TB and malignancy is crucial, as they have fundamentally different treatment strategies, with significant implications for prognosis.  \nIn the context of pulmonary involvement, both TBand malignant lesions can exhibit nonspecific symptoms, including cough, constitutional symptoms, and radiographic opacities (3) . Similarly, skeletal TB may manifest as osteolytic lesions or periosteal reactions, which may be indistinguishable from signs of metastatic bone disease in imaging studies (4) . Lymphadenopathy, a common  \ncharacteristic of both conditions, further complicates the diagnostic process (5) .  \nThe distinction between TB and malignancy is not solely an academic concern, and it carries substantial implications for patient management (4) . Anti-TB treatment is typically protracted and requires a specific therapeutic regimen, whereas malignancy often necessitates more aggressive interventions, including surgery, chemotherapy, or radiation therapy. Furthermore, misdiagnosing TB as malignancy, or vice versa, can result in inappropriate treatment, increased morbidity, and even mortality.  \nThis case report describes the diagnostic challenges encountered in a 43-year-old male patient who had lymphadenopathy, bone lesions, and pulmonary nodules. The differential diagnosis included consideration of TBand malignancy, which can exhibit overlapping clinical and radiological features.  \nCase presentation  \nThe patient was a 43-year-old male. In September 2021, he discovered enlarged, hard, nontender lymph nodes on the right clavicle while showering. There was no increase in local skin temperature, and he reported no fever, chills, cough, or sputum production. No treatment was given at that time. In December 2021, he experienced unexplained lower back pain, along with right chest wall pain, night sweats, and weight loss. Hydrocodone was prescribed for  \n^ ORCID: 0000-0002-1026-8815.  \n© AME Publishing Company. Quant Imaging Med Surg 2026;16(1):99 | [https://dx.doi.org/10.21037/qims-2025-1442](https://dx.doi.org/10.21037/qims-2025-1442)  \nPage 2 of 10 Wang et al. Tuberculosis mimicking metastatic lung ","cbCaieADllrGZqg7","https://ap.wps.com/l/cbCaieADllrGZqg7","pdf",1980902,"English","# Introduction\n# Case presentation\n## Patient history and symptoms\n# The diagnosis and treatment process (hospitals 1–6)\n## Hospital 1 (March 8)\n## Hospital 2 (March 10–30)\n## Hospital 3 (April 12)","[{\"question\":\"Why can tuberculosis be mistaken for malignancy in multisystem involvement?\",\"answer\":\"TB can disseminate beyond the lungs and produce clinical and radiological findings that resemble metastatic malignant disease, including similar imaging characteristics and lymphadenopathy.\"},{\"question\":\"What initial findings led clinicians to suspect metastatic malignancy?\",\"answer\":\"Chest CT suggested malignancy with mediastinal or hilar lymphadenopathy and destructive bone lesions, accompanied by markedly elevated CRP and later high FDG uptake on PET-CT.\"},{\"question\":\"How was tuberculosis confirmed despite some negative TB tests?\",\"answer\":\"Molecular testing identified M. tuberculosis nucleic acid in a left iliac bone biopsy, while TB-specific stains and PCR results varied among different biopsy sites, highlighting specimen-dependent discordance.\"}]","Distinguishing tuberculosis from malignancy when multisystem involvement occurs - a case description | PDF",1790748612,25]