Worldwide, Mycobacterium tuberculosis (MTB) is the leading cause of death due to a single infectious agent. According to the CDC, there were 9,025 reported new cases of active TB in the U.S. in 2018. There are various diagnostic modalities available to diagnose infection with MTB, whether it is latent or active. We present a diagnostically challenging case of pulmonary and pleural TB in a patient with known risk factors. It serves as a reminder of the high false negative rate of many of the tests for TB.
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