A 34-year-old male immigrant presents to the physician with a cough and fever. On his last visit 12 months ago, his PPD was positive and chest x-ray showed likely active tuberculosis. He was treated with INH and rifampin and his symptoms abated. On this visit, he appears very sick and has hard time breathing. He denies night sweats and hemoptysis. His temperature is 102.1°F. Chest x-ray reveals infiltrates in the right middle and lower lobes and a Ghon complex. He is still taking INH and rifampin, which do not seem to help. What is the most likely diagnosis?

A 34-year-old male immigrant presents to the physician with a cough and fever. On his last visit 12 months ago, his PPD was positive and chest x-ray showed likely active tuberculosis. He was treated with INH and rifampin and his symptoms abated. On this visit, he appears very sick and has hard time breathing. He denies night sweats and hemoptysis. His temperature is 102.1°F. Chest x-ray reveals infiltrates in the right middle and lower lobes and a Ghon complex. He is still taking INH and rifampin, which do not seem to help. What is the most likely diagnosis?

A 34-year-old male immigrant presents to the physician with a cough and fever. On his last visit 12 months ago, his PPD was positive and chest x-ray showed likely active tuberculosis. He was treated with INH and rifampin and his symptoms abated. On this visit, he appears very sick and has hard time breathing. He denies night sweats and hemoptysis. His temperature is 102.1°F. Chest x-ray reveals infiltrates in the right middle and lower lobes and a Ghon complex. He is still taking INH and rifampin, which do not seem to help. What is the most likely diagnosis?



Answer: TB relapse; note that the Ghon complex is consistent with primary healed TB and does not exclude reactivation on relapse.



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