Hemoptysis and Dyspnea Due to Suspected Pulmonary Tuberculosis with Pneumonia as a Differential Diagnosis

Abstract

Hemoptysis is a clinical symptom characterized by coughing up blood, originating from the lower respiratory tract. This symptom is often associated with pulmonary tuberculosis, with pneumonia being one of its differential diagnoses. Distinguishing between these two conditions in primary healthcare facilities can be challenging due to limited diagnostic resources. A 22-year- woman presented to a rural primary healthcare facility with complaints of a productive cough with fresh blood mixed with sputum, epigastric pain, nausea, vomiting, shortness of breath. Physical examination revealed tachypnea (RR: 24 breaths/min), oxygen desaturation (SpO₂ 93% on room air) and coarse bibasal crackles. Laboratory examination showed leukocytosis (13.2 × 10³/µL), while the sputum GeneXpert MTB/RIF result was still pending. The patient received supplemental oxygen therapy, intravenous antibiotic, nebulization, corticosteroids, antifibrinolytic therapy and supportive treatment according to the resource availability. This case highlights the diagnostic complexity of differentiating pneumonia from pulmonary tuberculosis in resource-limited primary healthcare settings. Although resources are limited, timely and appropriate diagnostic investigations are crucial to establish an accurate diagnosis. However, this patient first received emergency management and stabilization at the Community Health Center before further evaluation.