Pulmonary tuberculosis as a differential diagnosis of a pulmonary nodule: the great masquerader

Tuberculosis is known as one of “the great masqueraders” due to unusual and nonspecific symptoms it presents, which causes a challenge in diagnosis. There are rare radiological pulmonary patterns described in some case reports such as lung mass and bilateral pulmonary nodules similar to primary lung cancer or pulmonary metastases. We present a case of a 42-year-old man who was admitted to the emergency room due to pain and increased testicular volume. His chest tomography revealed a right lung mass and bilateral pulmonary nodules with a diffuse distribution. Therefore, based on clinical and radiological results, we suspected malignancy. His testicular fluid drainage resulted in a positive Ziehl Neelsen staining. The patient received anti-tuberculosis treatment for 1 month showing clinical and tomographic improvement. Pulmonary tuberculosis can present unusual radiological patterns. Therefore, we suggest that it should be considered in the differential diagnosis of patients with clinical and radiological characteristics of metastatic or primary lung disease. Diagnosis should be aided by invasive interventions.