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June 3, 1961

The Second "Great Imitator"—Tuberculosis

Author Affiliations

Phoenix. Ariz.

Chief of Medicine, U. S. Public Health Service Indian Hospital.

JAMA. 1961;176(9):809-810. doi:10.1001/jama.1961.63040220009017a

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IT HAS LONG BEEN KNOWN that syphilis is capable of mimicking many other diseases. That tuberculosis can also imitate various other conditions is less emphasized. However, an awareness of the atypical clinical manifestations of tuberculosis is increasingly important since the index of suspicion of a disease tends to subside with its decreasing prevalence.

The Indian population of southwestern United States affords an unusual opportunity for studying tuberculosis because the incidence of infection still remains much higher than for the general population. The present report concerns cases selected from experience at the Phoenix Public Health Service Indian Hospital during a 2-year period. In each individual, diagnostic confusion occurred because a nontuberculous condition was simulated in various regards.

Report of Cases 

Case 1.—  A 38-year-old Hualapai woman with severe pelvic "bone-pain" and fever was found to have multiple lytic lesions (Fig. 1) and hypergammaglobulinemia. The diagnosis of multiple myeloma or metastatic malignancy

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