Utilizing radial endobronchial ultrasound-guided lung biopsy to diagnose pseudotumoral tuberculosis in sputum-negative immunocompetent adults

Pseudotumoral pulmonary tuberculosis (TB) is a rare presentation of TB that mimics lung malignancy. This can occur even in immunocompetent adults with negative sputum TB GeneXpert results, making the diagnosis particularly challenging. This often leads to added psychological and financial burden, along with diagnostic delays. We describe three sputum-negative patients who presented with pulmonary mass on chest CT scan. Histopathologic confirmation for Pulmonary Tuberculosis (PTB) was obtained through radial endobronchial ultrasound (r-EBUS)-guided lung biopsy. This case series highlights the importance of maintaining a high index of suspicion for TB in patients with pulmonary mass in endemic countries. Furthermore, it emphasises the diagnostic utility of minimally invasive techniques such as EBUS-guided biopsy in differentiating PTB from malignancy, thereby facilitating early diagnosis and treatment initiation.