A 34-year-old man presents to the clinic with a persistent cough lasting for four weeks, occasional hemoptysis, night sweats, and unintentional weight loss of 10 pounds over the past month. He has no significant past medical history and is not on any medications. He smokes 10 cigarettes per day and drinks 3-4 beers per week. He recently returned from a trip to Southeast Asia. Vital signs are within normal limits except for a low-grade fever. On physical examination, he appears thin, and auscultation of the lungs reveals crackles in both upper lung fields. A chest X-ray reveals cavitary lesions in the upper lobes of the lungs.
A) Active tuberculosis disease
Active tuberculosis (TB) disease occurs when the bacteria multiply and cause symptoms. Common symptoms include a persistent cough lasting more than three weeks, hemoptysis, night sweats, weight loss, and fever. The patient's symptoms and chest X-ray findings are consistent with active TB disease, especially considering his recent travel to a region where TB is endemic.
Answer choice B: Acute bronchitis, is incorrect. Acute bronchitis typically presents with a cough and sometimes fever, but it does not usually cause hemoptysis, night sweats, or significant weight loss, nor does it show cavitary lesions on chest X-ray.
Answer choice C: Community-acquired pneumonia, is incorrect. Community-acquired pneumonia can cause cough and fever, but it typically presents with more acute symptoms and does not usually cause night sweats or significant weight loss, nor does it typically show cavitary lesions on chest X-ray.
Answer choice D: Latent tuberculosis infection, is incorrect. Latent tuberculosis infection (LTBI) occurs when the bacteria are present in the body but inactive, causing no symptoms. This patient has symptoms indicative of active disease.
Answer choice E: Lung cancer, is incorrect. While lung cancer can present with cough, hemoptysis, and weight loss, the presence of night sweats and the recent travel history make active TB more likely.
Key Learning Point
Latent TB infection (LTBI) occurs when the bacteria are present in the body but inactive, causing no symptoms. Active TB disease occurs when the bacteria multiply and cause symptoms. Common symptoms include a persistent cough lasting more than three weeks, hemoptysis (coughing up blood), night sweats, weight loss, and fever.
