Author Affiliation: Dr Iseman is Professor of Medicine, University of Colorado School of Medicine, Denver.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR DELBANCO: Mr Z is a 52-year-old college
professor with a dry, hacking cough. Born in India and raised in Bangladesh,
Mr Z immigrated to the United States more than 20 years ago. He lives in Boston
with his wife and daughter and has managed care insurance.
Mr Z had a negative purified protein derivative (PPD) test result 15
years ago. He recently traveled to Bangladesh for 3 weeks. Upon returning
from his trip with a persistent hacking cough, he saw a primary care nurse
practitioner who prescribed a steroid inhaler; the cough resolved slowly.
A PPD test yielded 22 × 28 mm of induration. Results of a chest radiograph
were normal. On his recent trip, he had no known contacts with tuberculosis
(TB). His BCG vaccination status is unknown.
Iseman M. A 52-Year-Old Man With a Positive PPD. JAMA. 2001;286(16):2015-2022. doi:10.1001/jama.286.16.2015