Poncet disease in a patient with smear-negative pulmonary tuberculosis: A case report

High-resolution computed tomography (HRCT) of the thorax was planned, and it showed multiple solid, ground glass and part-solid nodules in the bilateral lungs. The patients condition was then treated as smear-negative pulmonary tuberculosis with a standard antituberculosis regimen involving a 2-month intensive phase with isoniazid, rifampicin, pyrazinamide and ethambutol, followed by a 4-month maintenance phase with isoniazid and rifampicin. The symptoms of smear-positive and smear-negative pulmonary tuberculosis can be similar.3 A retrospective study found that the absence of cough and the absence of a radiographic pattern typical of tuberculosis were associated with smear-negative tuberculosis.4 In the present case, the diagnosis of pulmonary tuberculosis was delayed because Madam R presented only with weight loss, a transient history of fever and negative acid-fast bacillus sputum smears. The algorithm for diagnosing smear-negative pulmonary tuberculosis developed by the World Health Organization in 2003 requires at least three negative sputum smears, chest radiography findings consistent with tuberculosis and a lack of response to a trial of broad-spectrum antimicrobial agents.5 Two sputum samples from Madam R obtained via direct sputum collection and one sample via bronchoalveolar lavage were negative.