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Pneumologia ; 65 3 : When microscopy is repeatedly negative during noninvasive methods, lung biopsy by thoracoscopy is needed for confirmation and differential diagnosis.

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Case presentation: A year-old female patient nonsmoker, diabetic, with previous exposure to chemicals was admitted to the hospital for weight loss, dry cough, loss of appetite, pallor, and fatigue. Chest-X-ray and thoracic CT revealed multiple irregular macronodules with various shapes, randomly spread across the lungs.

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Bacteriology for acid fast bacilli AFB from six spontaneous sputum was negative. Bronchoscopy showed an acute bronchitis. Bronchial aspirate was negative for tumor cells and AFB.

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Several biopsies from bronchial wall showed unspecific changes. The molecular biology tests for specific nucleic acids detection Polymerase Chain Reaction or positron-emission-tomography to differentiate benign nodules from malign ones were not accessible.

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Multiple biopsies from lung parenchyma and pleura were obtained using thoracoscopy. Histopathology revealed multiple specific tuberculous granulomas.

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The complex antituberculous treatment 9 months has led to the total cure of the disease and resorption of the nodules. Conclusion: Tuberculosis may present in the form of multiple macronodules spread randomly across abdominal cancer symptoms female lung parenchyma. Histological exam from thoracoscopic biopsies allows differential diagnosis between entities that have macronodular features: tuberculosis, primitive lung cancer, lymphomas, metastatic disease or invasive fungal disease.

abdominal cancer symptoms female