Context

Pulmonary tuberculosis (TB) remains a significant diagnostic challenge in HIV-positive patients due to the overlapping presentations of infectious, neoplastic, and inflammatory diseases. This complexity is exacerbated by the presence of multiple comorbidities, such as diabetes mellitus and hypertension, which can further alter the clinical picture.

Aims

To describe the clinical presentation, diagnostic process, and management of a complex case of pulmonary tuberculosis in an HIV-positive patient, highlighting the role of molecular diagnostics and a multidisciplinary approach.

Results

A 58-year-old female presented with a persistent cough, hemoptysis, weight loss, and fever. Initial imaging revealed a left hilar mass with mediastinal lymphadenopathy, raising suspicion of malignancy. Bronchoscopy was inconclusive. A line probe assay (LPA) confirmed pulmonary tuberculosis. The patient was successfully treated with anti-tuberculosis therapy (ATT), and her ART was adjusted to prevent immune reconstitution inflammatory syndrome (IRIS). The patient's comorbid diabetes was managed concurrently.

Conclusion