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Cough and weight loss in a 34-year-old farmer
Internal Medicine
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Case Presentation
A 34-year-old tobacco farmer from Mukono presents with a 6-week history of productive cough, night sweats, and unintentional 8 kg weight loss. He has no prior medical history. On examination: BMI 17.2, bilateral coarse crackles in the upper zones, no peripheral lymphadenopathy.
Question
What is the most likely diagnosis and what three investigations would you order first?
Answer
Most likely: pulmonary tuberculosis. First-line investigations: 1) Sputum GeneXpert MTB/RIF, 2) Chest X-ray (postero-anterior), 3) HIV test.
Clinical Pearl
Upper-zone crackles + constitutional symptoms in a high-burden setting = think TB first, not pneumonia.