The patient is a 56-year-old female who visited the primary care clinic to request a Mantoux or tuberculin skin test (TST), a test that required to update her nursing school file. She is in perfect health condition, with no symptoms or complaints of any sort.
She was born in Cuba, where she was vaccinated with the Bacillus Calmette-Guerin (BCG) at birth. She migrated to the United States three years ago. The patient denied having any history of or being in close contacts with anyone with tuberculosis disease or a chronic cough. She does not have a cough, night-time fever, fatigue or chills, working or residing in facilities or institutions with people who are at high risk for TB such as hospitals that care for TB patients, homeless shelters, correctional facilities, nursing homes, or residential facilities for patients with HIV infection/AIDS. She also denied having any previous or current diagnosis of silicosis, diabetes mellitus, chronic renal failure or on hemodialysis, gastrectomy, jejunoileal bypass, solid organ transplant, or head cancer. The urine drug test was negative (Center for Disease Control and Prevention USA).
Her past medical history is unremarkable except for a history of papillary thyroid cancer. Her thyroid was removed via 131 radioactive iodides (thyroid ablation) 35 years ago. Since then she has been taking thyroxin replacements (Thyroxin-T4; 100 mug) once/day. She also suffers from gastroesophageal reflux and is on Omeprazole 1 capsule/day for over seven years now. In 2017 she had a gastroscopy, and a colonoscopy performed that revealed standard results. She had a hysterectomy 16 years ago due to massive intramural fibroids. She does not drink or smoke. She has no history of any allergies and is not known to be on any habit-forming medications. She is a very highly educated lady who lives with family members. Her father died 31 years ago from liver cancer and her mother two years ago from a thrombotic stroke. She is the last of four living siblings, all in good health conditions.
Her current physical examination was satisfactory. She is in no form of distress. She has normal vital signs with a bodyweight of 162 pounds. Her laboratory results such as full blood count, urea, electrolytes, and liver function tests are unremarkable. Her chest X-Ray reveals standard cardiac size and configuration. The lungs are clear and expanded. She has no active disease and no radiographic evidence of active or prior primary tuberculosis. Quantiferon Gold test was negative three years ago, and this year was still negative. The tuberculin skin test (TST) done this year was positive. The diameter of the skin induration was 15 mm (Fig. 1).