Resumen

ROJAS-ROJAS, Eva Alejandra; CINENCIO-CHAVEZ, Wendy Rosario  y  LANIADO-LABORIN, Rafael. Delayed diagnosis of tuberculosis in a patient with coccidioidomycosis. Neumol. cir. torax [online]. 2023, vol.82, n.4, pp.253-255.  Epub 07-Abr-2025. ISSN 0028-3746.  https://doi.org/10.35366/117942.

We present the case of a 24-year-old man from Sonora, residing in Tijuana, Mexico, who referred symptoms of cough and hemoptysis for a year. A chest CT scan showed fibrocavitary lesions, initially suspected to be tuberculosis. Rapid molecular tests did not detect Mycobacterium tuberculosis, while coccidioidomycosis serology was positive and cultures identified Coccidioides spp.; treatment with itraconazole was initiated, but subsequently, the mycobacterial culture was reported as positive for M. tuberculosis, confirming coinfection and antituberculosis treatment was added. The Xpert MTB/RIF test is recommended by the World Health Organization as an initial diagnostic method for tuberculosis due to its high sensitivity and specificity. However, its sensitivity can be low in cases of very low bacillary load, justifying the need for complementary mycobacterial cultures for a thorough diagnosis. In this case, the culture allowed for the detection of tuberculosis despite negative sputum smears and rapid molecular tests, highlighting the importance of phenotypic methods in the diagnosis of tuberculosis. The coinfection of tuberculosis and coccidioidomycosis is a significant diagnostic challenge. The combination of molecular tests and cultures remains essential for an accurate diagnosis and effective treatment, especially in endemic areas for both diseases.

Palabras llave : tuberculosis; coccidioidomycosis; coinfection; Xpert MTB/RIF; mycobacterial culture.

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