Tuberculosis (TB) Differential Diagnoses (original) (raw)
Diagnostic Considerations
Tuberculosis (TB) is well known for its ability to masquerade as other infectious and disease processes. For example, congenital TB can mimic congenital syphilis or cytomegalovirus (CMV) infection. Along with the differentials listed in the next section, conditions with a presentation that may resemble pulmonary TB include the following:
- Squamous cell carcinoma
Conditions to be included in the differential diagnosis of extrapulmonary TB include the following:
- Blastomycosis
- Tularemia
- Actinomycosis
- M avium-intracellulare infection
- M chelonae infection
- M fortuitum infection
- M gordonae infection
- M kansasii infection
- M marinum infection
- M xenopi infection
Dermatologic differential diagnosis:
Diagnosis of skin infection with M tuberculosis involves the following:
- Differentiate primary-inoculation TB from ulceroglandular complexes and mycobacteriosis
- Differentiate TB verrucosa cutis from diseases such as North American blastomycosis, chromoblastomycosis, iododerma and bromoderma, chronic vegetative pyoderma, verruca vulgaris, verrucous carcinoma, verrucous atypical mycobacterial infection, and verrucous lupus vulgaris
- Differentiate miliary TB of the skin (which appears as small, noncharacteristic, erythematous, papular, or purpuric lesions) from drug reactions.
- Differentiate scrofuloderma from suppurative lymphadenitis with sinus-tract formation, such as blastomycosis or coccidioidomycosis.
- Differentiate TB cutis orificialis from glossitis, apotheosis, and deep fungal infections.
- Differentiate lupus vulgaris from lupoid rosacea, deep fungal or atypical mycobacterial infection, chronic granulomatous disease, granulomatous rosacea, and Wegener granulomatosis.
- Differentiate erythema induratum from nodular panniculitides (eg, Weber-Christian disease) and nodular vasculitides (eg, syphilitic gumma, nodular pernio)
- Differentiate papulonecrotic tuberculid from other papulonecrotic entities, such as leukocytoclastic vasculitis, lymphomatoid papulosis, papular eczema, and prurigo simplex with neurotic excoriation.
- Differentiate lichen scrofulosorum from keratosis spinulosa, lichenoid sarcoid, and lichenoid secondary syphilis
Differential Diagnoses
- Actinomycosis
- Aspergillosis
- Bronchiectasis
- Constrictive Pericarditis
- Fungal Pneumonia
- Histoplasmosis
- Lung Abscess
- Nocardiosis
- Non-Small Cell Lung Cancer (NSCLC)
- Pott Disease (Tuberculous [TB] Spondylitis)
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Author
Coauthor(s)
Nelson Ivan Agudelo Higuita, MD, DTM&H, CTH® Edith Kinney Gaylor Presidential Professor, Associate Professor, Program Director, Infectious Diseases Fellowship Program, Medical Director, Refugee and Travel Clinic, Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center; Attending Physician, Infectious Diseases Consultation Service, Department of General Internal Medicine, Oklahoma University Medical Center
Nelson Ivan Agudelo Higuita, MD, DTM&H, CTH® is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.
Maria Alkozah, MD, MPH Assistant Professor of Medicine, University of Oklahoma College of Medicine; Faculty, Section of Infectious Diseases, Department of Medicine, Medical Director for Antimicrobial Stewardship, Medical Director for the Outpatient Antimicrobial Therapy Program, University of Oklahoma Medical Center
Maria Alkozah, MD, MPH is a member of the following medical societies: American College of Preventive Medicine, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America
Disclosure: Nothing to disclose.
Chief Editor
Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.
Additional Contributors
Acknowledgements
Erica Bang State University of New York Downstate Medical Center College of Medicine
Disclosure: Nothing to disclose.
Diana Brainard, MD Consulting Staff, Department of Infectious Disease, Massachusetts General Hospital
Disclosure: Nothing to disclose.
Pamela S Chavis, MD Professor, Department of Ophthalmology and Neurosciences, Medical University of South Carolina College of Medicine
Pamela S Chavis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Ophthalmology, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.
Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine
Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Aaron Glatt, MD Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)
Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and SocietyforHealthcareEpidemiology of America
Disclosure: Nothing to disclose.
Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.
John M Leedom, MD Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California
John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.
James Li, MD Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine
Disclosure: Nothing to disclose.
Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.
Monte S Meltzer, MD Chief, Dermatology Service, Union Memorial Hospital
Monte S Meltzer, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.
Susannah K Mistr, MD Resident Physician, Department of Ophthalmology, University of Maryland Medical Center
Susannah K Mistr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Medical Student Association/Foundation, American Society of Cataract and Refractive Surgery, and South Carolina Medical Association
Disclosure: Nothing to disclose.
Carol A Nacy, PhD Adjunct Professor, Department of Biology, Catholic University of America; Adjunct Professor, Department of Tropical Medicine and Microbiology, George Washington University
Carol A Nacy, PhD is a member of the following medical societies: American Academy of Microbiology and American Society for Microbiology
Disclosure: Sequella, Inc. Ownership interest Employment; Sequella, Inc. Ownership interest investor
J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.
Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.
John D Sheppard Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants
John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.
Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
Keith Tsang, MD Resident Physician, Clinical Assistant Instructor, Department of Emergency Medicine, State University of New York Downstate, Kings County Hospital
Keith Tsang, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Shyam Verma, MBBS, DVD, FAAD Clinical Associate Professor, Department of Dermatology, University of Virginia; Adjunct Associate Professor, Department of Dermatology, State University of New York at Stonybrook, Adjunct Associate Professor, Department of Dermatology, University of Pennsylvania
Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.
Eric L Weiss, MD, DTM&H Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Progressor, Department of Surgery (Emergency Medicine), Stanford University Medical Center
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.