# A Case of Recurrent Sputum-Positive Pulmonary Tuberculosis Presenting With Pulmonary Mycetoma

## TL;DR

This case study presents a rare instance of a tuberculosis patient who also developed pulmonary mycetoma, highlighting the importance of accurate diagnosis to avoid severe health outcomes.

## Contribution

The paper highlights a rare co-infection of tuberculosis and mycetoma, emphasizing the need for differential diagnosis to prevent mismanagement.

## Key findings

- The patient's failure to continue anti-tubercular medication led to disease recurrence.
- Combination therapy with anti-tubercular drugs and itraconazole was initiated.
- Surgical excision is recommended over pharmacotherapy for mycetoma in tuberculosis patients.

## Abstract

Pulmonary tuberculosis is a notorious disease as it can cause severe morbidity and mortality. In this case, we discuss a 75-year-old male tuberculosis patient from a rural area with no underlying comorbidities who failed to continue anti-tubercular medication after two months. The case discusses the diagnostic modalities confirming the diagnosis, sputum culture for Mycobacterium tuberculosis, imaging studies, including X-ray and CT of the chest, and laboratory parameters for identifying pulmonary mycetoma. The patient is now on anti-tubercular therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol combination) and the anti-fungal drug itraconazole. Though pharmacotherapy for the treatment of mycetoma in patients with tuberculosis has a minimal role, the more appropriate treatment is surgical excision via lobectomy. As the occurrence of tuberculosis and mycetoma is a rare phenomenon, it is essential to rule out aspergillosis as both have similar presenting symptoms. Diagnosis of this co-infection can be the crucial difference between morbidity and mortality.