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Clinical Crossroads
October 24/31, 2001

A 52-Year-Old Man With a Positive PPD

Author Affiliations

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.

JAMA. 2001;286(16):2015-2022. doi:10.1001/jama.286.16.2015

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.

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