• Paloma Manea, Madalina Bodescu, Mirela Grigorovici, Mihaela Archip, Cristian Badescu, and Rodica Ghiuru.
• Chest. 2014 Mar 1;145(3 Suppl):98A.

Session TitleTuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Comorbidities could become pitfalls for a correct diagnosis. Physical signs may suggest an active disease, if appropiate investigations are not effectuated.Case PresentationA 50 years old male patient was diagnosed (2011) with ankylosing spondylitis by the rheumatologist (sacroiliitis,specific modifications of the vertebral bodies, anterior uveitis and HLA-B27 positive).He had a 7.1 BASDAI score(Bath Ankylosing Spondylitis Disease Activity Index) and he received Sulfasalazine 2g/day,without significant improvement.He remarked fever,sweating and decreased appetite, since July 2013.Physical examination specified a left submandibular tumour 10/10 mm, with fistula.Montaux tuberculin skin test was positive: 25 mm(blister); Quanti-FERON-TB Gold test was also positive: above 10IU/ml-negative values: bellow 0.35; echocardiography revealed fibrous pericarditis (7mm pericardial thickening); computed thoracic tomography indicated left anterior phrenicocostal sinus pleura thickening:10 mm and perihilar calcified pulmonary nodules.As a first diagnosis (at this step) for this submandibular tumour with fistula we thought at active lymph node tuberculosis.The surprise was the morphopathological diagnosis of the tumour:lymphoepithelial cyst with fistula.The cultures from sputum, urine and pustula'pus were all negative for Mycobacterium tuberculosis.The pneumologist considered a recent (bellow 2 years) Mycobacterium tuberculosis infection (but not active) and recommended a delay of treatment with Tumour-Necrosis-Factor alpha blockers, indicated for spondylitis,with revaluation after 6 months.DiscussionOur case proved the fact that first clinical thought could not be the appropiate diagnosis,without strong evidences.ConclusionsOnly interdisciplinary work could nowadays alllow a correct diagnosis.Reference #1: Nahid P., Pai M, Hopewell P.C.,Advances in the diagnosis and treatment of tubrculosis,Proc Amer Thoracic Soc 3:103-110Reference #2: Kim E.M.,Uhm W.,Bae S.C.,Yoo D.H.,Kim T.H.,Incidence of tuberculosis among korean patients with Ankylosing spondylitis who are taking tumor necrosis factor blockers,J Rheumatol 2011Oct;38(10):2218-23DISCLOSURE: The following authors have nothing to disclose: Paloma Manea, Madalina Bodescu, Mirela Grigorovici, Mihaela Archip, Cristian Badescu, Rodica GhiuruNo Product/Research Disclosure Information.

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