The forgotten tuberculosis: a case report

Abstract

Introduction: The articulation between primary care and secondary care and the Pulmonology Diagnostic Centers is particularly important in the management of an insidious disease with a great impact on public health such as tuberculosis. The present case highlights the role of the family doctor in the articulation of care and its importance in the identification and guidance of a possible tuberculosis condition.

Case description: Female adolescent, 16 years old, with a history of autoimmune thyroiditis under levothyroxine, iron deficiency anemia under supplementation, and anxiety disorder. Refers to a consultation with the family doctor in 2019 due to a cervical adenomegaly with two weeks of evolution, without warning signs, and an anti-inflammatory was prescribed. Referral to pediatric surgery consultation at a central hospital through urgent pediatric care at the referral hospital, due to persistent adenomegaly after empirical antibiotic treatment and normal analytical study. An aspiration biopsy was performed five months later, with discharge from the consultation due to the absence of malignancy, with no other relevant information. Observed in an emergency context at the referral hospital, six months later, due to new cervical adenomegaly, an alert was made by the family doctor after the detection of isolation of Mycobacterium tuberculosis in a lymph node biopsy performed at the central hospital. Consequent follow-up at the Pneumological Diagnosis Center for lymph node and pulmonary tuberculosis, having undergone lymph node excision and under anti-bacillary treatment, with a favorable clinical outcome.

Comment: Tuberculosis is a particular clinical challenge due to the diversity of presentations. This case demonstrates the complexity of managing these patients and the importance of creating alerts in case of a positive mycobacteriological result. The role of the family doctor, as it is often the patient's first contact with healthcare and the bridge to other services, entails an important responsibility in identifying these patients and preventing the chain of transmission.