A70-30 The Low-burden Blind Spot: Cavitary Tb in a Repeatedly Igra-negative Locum Nurse
Abstract
In low-incidence countries, tuberculosis (TB) screening programs for healthcare workers rely on periodic IGRA testing and passive symptom reporting. However, transient clinicians, such as locum and home-health nurses, often operate across multiple care environments and may fall outside consistent occupational surveillance systems. In such settings, prior negative screening may create false diagnostic reassurance, even in the presence of evolving symptoms. We describe a case of advanced cavitary pulmonary TB in a locum nurse with repeated prior TB clearance and multiple missed opportunities for early diagnosis in primary care.
A 40-year-old Filipino-born male working as a locum/home-health nurse presented with 3 months of dark-brown sputum, one episode of hemoptysis, intermittent fevers, pleuritic chest pain, decreased appetite, and ½-pack/day smoking history. He reported travel to Mexico 1 year earlier and multiple negative IGRA tests 2-3 years prior for employment clearance.Despite several prior outpatient visits for persistent cough, fever, fatigue, and myalgias, he was repeatedly diagnosed with “viral URI” and received only symptomatic therapy.On admission, he was febrile with WBC 15 K/µL and newly identified uncontrolled diabetes (glucose 315 mg/dL; HbA1c 11.9%). CXR showed a dense left-upper-lobe infiltrate; CT revealed cavitary consolidation with multifocal nodularity. Empiric broad-spectrum therapy for presumed bacterial pneumonia was initiated. On hospital day 3,…
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