Pulmonary tuberculosis: Chest radiograph can appear normal in immunocompromised patients

doi:10.1136/bmj.332.7554.1392-a

BMJ 2006;332:1392 (10 June), doi:10.1136/bmj.332.7554.1392-a

Letter

Pulmonary tuberculosis

Chest radiograph can appear normal in immunocompromised patients

The first 150 words of the full text of this article appear below.

EDITOR—Campbell and Bah-Sow describe the varied patternsof abnormality in chest radiographs in patients with pulmonarytuberculosis, appearances often being less specific in immunocompromisedpatients.¹ We agree that a high index of suspicion is necessaryin such patients and highlight the inadequacy of a chest radiographin excluding pulmonary tuberculosis.

Our hospital is in a major suburban town in Greater London andhas an ethnically diverse and unusually mobile population. Inthe past 12 months, 16% of cases of pulmonary tuberculosis (excludingmediastinal lymphadenitis and pleural disease) had co-infectionwith HIV. In one such case the chest radiograph was completelynormal while sputum was smear positive.

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Credit: CDC

This occurs more often than we expected: in 2004 a paper fromAddis Ababa showed that 9.2% of patients with HIV and cultureproved pulmonary tuberculosis had a normal chest radiograph.²An earlier paper from Rome showed that 9% of . . . [Full text of this article]

Ben C Creagh-Brown, specialist registrar respiratory medicine

Mayday University Hospital, Thornton Heath, Surrey CR7 7YE drbencb@gmail.com

Ruth Whitfield, associate specialist in respiratory medicine

Mayday University Hospital, Thornton Heath, Surrey CR7 7YE