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[Clinical Picture] Excavated pulmonary lesions: differential diagnosis in a health-care worker

A healthy 55-year-old Italian nurse, with a history of bilateral nasal polyposis, had occupational screening after contact with a patient diagnosed with pulmonary tuberculosis. She had no other medical history of note (including diabetes or gastro-oesophageal reflux disease) and reported no other contact with tuberculosis. She could not recall having had previous BCG vaccination. A Mantoux skin test was positive (about 10 mm). Chest radiograph showed two lesions in the left lower lobe: an air-filled nodule with slightly thickened walls of about 2 cm diameter, and another solid nodule about 1 cm diameter (appendix).