A 58 year old caucasian male, nonsmoker, with h/o hypertension and gout presents with shortness of breath. He has lost 20 lbs of weight in the last 2 yrs which he attributes to life stressors and poor appetite and endorses having had long-term asbestos exposure.

Chest Xray showed bilateral non-specific nodular lesions and pleural effusion. CT scan of the chest showed bilateral pulmonary nodules suggestive of metastatic cancer or infection, right lower lobe mass, bilateral pleural effusion, worse on the right, and a large hypodense soft tissue mass in the lower abdomen. No evidence of mediastinal or hilar adenopathy

The transbronchial biopsy was positive for chronic inflammation and AFB. A sputum sample was sent for culture and showed pan-sensitive TB. Patient was started on Directly Observed Therapy (4 drugs – for 9 months). Follow-up CT showed no change in the original pulmonary nodules, decrease in size of the right lower lobe mass and slight decrease in the pleural effusion. Patient improved clinically.
Follow up PET/CT showed significantly decreased FDG activity in the lung lesions, along with a generalized decrease in size, suggesting a good response of pulmonary TB to the 4-drug therapy.

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