SHM Converge Scientific Abstract ePoster Gallery-Diagnostic and Therapeutic Challenges of Culture-Negative Pulmonary Tuberculosis

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This case report discusses <strong>culture-negative tuberculosis (TB)</strong> as part of a continuum between latent infection and active disease. Culture-negative TB occurs when a patient has clinical and/or radiographic evidence strongly suggestive of active TB, but sputum smear and culture testing are negative. These cases often have a <strong>lower symptom burden</strong> and may show a <strong>rapid response to treatment</strong>, but they still carry a risk of progression and community transmission if not recognized and treated.

The report presents a <strong>45-year-old man</strong> recently immigrated from Mexico who developed <strong>fever, night sweats, and hemoptysis</strong>. His workup showed a strongly positive <strong>IGRA</strong>, elevated inflammatory markers, and imaging with <strong>bilateral cavitary nodules</strong>. Despite this, <strong>sputum AFB stain, sputum culture, BAL, and biopsy</strong> were negative or nondiagnostic. Given the high clinical suspicion for TB, he was started on <strong>multidrug antitubercular therapy</strong> (rifampin, isoniazid, ethambutol, and pyrazinamide), followed by rifampin/isoniazid continuation therapy. He had <strong>clinical and radiologic improvement within one month</strong>, with near resolution on chest imaging.

The authors emphasize that there are <strong>no universally accepted management guidelines</strong> for culture-negative TB, but early studies support <strong>multidrug therapy</strong>, and prolonged treatment is not necessarily superior to shorter regimens. Their key clinical message is that internists should maintain a <strong>low threshold for treatment and expert consultation</strong> when TB is strongly suspected, even if cultures are negative, to prevent morbidity and transmission.

Asset Subtitle

Regina Koch

Meta Tag

Author List Regina Koch, Skylar Rizzo

Category Clinical Vignettes

Concept Culture-Negative Tuberculosis

Concept Multidrug Antitubercular Therapy

Concept Latent Tuberculosis

Concept Active Tuberculosis

Concept TB Expert Consultation

Distinguished Non-Finalist

Presenter Organization The Mayo Clinic

Presenting Author Regina Koch

Track Adult

Keywords

culture-negative tuberculosis

TB

latent infection

active disease

hemoptysis

bilateral cavitary nodules

IGRA

multidrug antitubercular therapy

rifampin isoniazid ethambutol pyrazinamide

expert consultation

Culture-Negative Tuberculosis

Multidrug Antitubercular Therapy

Latent Tuberculosis

Active Tuberculosis

TB Expert Consultation