INT J TUBERC LUNG DIS 5(5):455–461

© 2001 IUATLD

Atypical radiological images of pulmonary tuberculosis in

192 diabetic patients: a comparative study

C. Pérez-Guzmán,*† A. Torres-Cruz,* H. Villarreal-Velarde,‡ M. A. Salazar-Lezama,* M. H. Vargas*§

* Instituto Nacional de Enfermedades Respiratorias, † Departamento de Neumología, Hospital General, CMN La Raza,
Instituto Mexicano del Seguro Social, ‡ Hospital General “Dr. Manuel Gea González”, § Hospital de Pediatría,
CMN Siglo XXI, Instituto Mexicano del Seguro Social, México DF, México

SUMMARY

S E T T I N G : Comparative studies of pulmonary tubercu-
losis images in diabetics have yielded conflicting results.
O B J E C T I V E : To assess radiological images of pulmonary
tuberculosis in a large population of diabetic patients.
D E S I G N : Radiographs from in-patients admitted with
pulmonary tuberculosis and diabetes (TBDM group, n 
192) were reviewed and compared with a control group
of patients with pulmonary tuberculosis alone (TB group,
n  130).
R E S U L T S : Both groups had a similar evolution time of
tuberculosis (~2 years). Statistical differences were
observed as follows: TBDM patients were older (51.3 
0.9 vs. TB group 44.9  1.8 years, mean  SEM), and
had a decreased frequency of upper (17% vs. 56%), and an
increased frequency of lower (19% vs. 7%) and upper 
lower (64% vs. 36%) lung field lesions. More TBDM
patients developed cavitations (82% vs. 59%) more
often in the lower lung fields (29% vs. 3%). More mul-
tiple cavities were seen in TBDM patients (25% vs. 2%).
TBDM group had a lower total leukocyte count (8836.7 
219.5 vs. 10013.1  345.2 cells/mm3), mainly due to a
lower number of non-lymphocyte cells (6815.8  221.8
vs. 8095.7  321.9 cells/mm3). Multiple logistic regres-
sion showed that being a diabetic patient was the most
important factor determining lower lung field lesions
and cavities.
C O N C L U S I O N S : This study in a large number of diabet-
ics with pulmonary tuberculosis confirmed that their
chest X-ray images significantly depart from the typical
presentation. Clinicians must keep this in mind to avoid
misdiagnosis.
K E Y W O R D S : cavitation; chest X-rays; comparative study;
diabetes mellitus; pulmonary tuberculosis; radiology;
roentgenogram

DIABETIC PATIENTS are considered a high-risk
population for the development of pulmonary tuber-
culosis. In a number of published comparative studies
chest X-ray images from these patients have been
described as ‘atypical’, mainly because they frequently
involve the lower lung fields, often with cavities.1–5
These radiological disparities in diabetic patients have
been attributed to cell-mediated immunological abnor-
malities and to polymorphonuclear cell dysfunction.1
However, other authors have been unable to find dif-
ferences in the chest X-ray patterns of pulmonary
tuberculosis in diabetic and non-diabetic patients
(Table 1).6–8 Almost all of these studies included a rel-
atively low number of diabetic patients, and some
even lacked statistical analysis, which could partially
account for the contrasting results. Moreover, in a
recent study we found that these ‘atypical’ images in
diabetic patients are common at any age, whereas in
non-diabetics their frequency progressively increased
from early adulthood.9 The aim of the present work
was to report additional features on the radiological
presentation of tuberculosis in these populations.
METHODS
The main characteristics of the studied population
have been described elsewhere.9 Briefly, clinical records
from all in-patients admitted to the Instituto Nacio-
nal de Enfermedades Respiratorias (INER, Mexico
City) from 1989 to 1993 with the diagnosis of pulmo-
nary tuberculosis plus diabetes mellitus (TBDM group)
were retrospectively reviewed. After excluding patients
with miliary or pleural tuberculosis, a total of 192
patients were included in the study. Pulmonary tuber-
culosis was confirmed by 1) positive acid-fast bacilli
in sputum, and/or 2) positive culture for Mycobacte-
rium tuberculosis in sputum, and diabetes mellitus by
at least two fasting serum glycemia over 140 mg/dl.
Although a positive sputum culture yielding M. tuber-
culosis was obtained in only 20% of these patients,

Correspondence to: Dr Mario H Vargas, Instituto Nacional de Enfermedades Respiratorias, Tlalpan 4502, CP 14080, Méx-
ico DF, Mexico. Tel: (52-5) 665-0043/665-6696. Fax: (52-5) 665-4623, 665-4748. e-mail: mhvargas@conacyt.mx
Article submitted 27 June 2000. Final version accepted 16 February 2001.
456 The International Journal of Tuberculosis and Lung Disease

Table 1 Comparative studies in which radiological features of pulmonary tuberculosis in diabetic

and non-diabetic patients were compared

Number of
tuberculous patients Radiological findings
Author (year) Country Diabetic Non-diabetic Site of lung lesions Cavitations
Weaver (1974)1 USA 20 182 More lower lobe involve- —
ment in diabetic patients
Marais (1980)2 South Africa 9 427 More lower lung field —
lesions in diabetic patients
Ghinescu et al. (1989)7 Romania 68 73 No difference No difference
Ikezoe et al. (1992)3 Japan 39* 71 No difference More multiple-cavities
in diabetic or immuno-
compromised patients
Morris et al. (1992)6 USA 20 20 No difference No difference
Umut (1994)4 Turkey 37 37 More multilobar involve- More cavitations in
ment in diabetic patients diabetic patients
Al-Wabel et al. (1997)8 Saudi Arabia 28 38 No difference No difference
Nakamoto & Saito (1998)5 Japan 19 70 — More cavitations in
diabetic patients

* Included eight immunocompromised patients without diabetes.

—  the feature was not reported.

the frequency of atypical mycobacteria in our insti-
tute is rather low (~0.1%).
The control group (TB group) was retrospectively
integrated by searching in the INER databases for
those in-patients discharged from 1990 through 1994
and without diabetes. A sample of patients with bac-
teriological confirmation (as described for the dia-
betic group) was randomly collected. After excluding
those cases with miliary or pleural tuberculosis, a
final sample population of 130 cases was obtained.
INER, the institute where this study was carried
out, is a national reference center for respiratory dis-
eases located in Mexico City. In this institution, the
main criteria for hospital admission of tuberculous
patients included advanced malnutrition, hemoptysis,
respiratory failure, uncontrolled diabetes mellitus,
multidrug resistance, pleural effusion, and miliary
tuberculosis. However, approximately one third of hos-
pitalized tuberculous patients are admitted for treat-
ment or diagnosis confirmation even in the absence of
the above-mentioned criteria. In our studied popula-
tion there were no patients with risk factors or clini-
cal suspicion of AIDS or human immunodeficiency
virus infection or any other immunodeficiency. In
addition, in Mexico there is no clear race distinction
as occurs in other countries, and thus racial stratifica-
tion was not necessary.
All initial posteroanterior and lateral chest roent-
genograms were reviewed by one of the pneumolo-
gists participating in the study (CPG or AT). Although
the reviewers were unblinded regarding the diabetic
status of the patients, the radiological evaluation was
simple enough as to consider that potential interpre-
tation biases, if any, were relatively small. Tubercu-
lous lesions and cavities were classified as located in
the upper or lower lung field when they appeared
mostly in the upper or lower half, respectively. A cav-
itary lesion was considered to be present when its
diameter was larger than 2 cm. Chest X-rays with dif-
ficult images (mainly those with doubtful cavities)
were jointly interpreted by both reviewers.
The statistical analysis to compare continuous
variables was performed by using the Mann-Whitney’s
U test. This non-parametric test was preferred because
some variables did not follow a normal distribution.
Differences of frequencies were assessed through
Yates-corrected 2 test or, when necessary, Fisher’s
exact test. Additionally, multiple logistic regression
(forward conditional model) was used to assess the
contribution of each predictor variable to the occur-
rence of lower lung field lesions or cavitations. In
this last analysis, nominal variables were dummy
coded to 1 and 0 and leukocyte count was excluded
due to collinearity with other variables. Statistical
significance was set at two-tailed P  0.05. Statisti-
cal tests were done using Epi-Info v6.0 (Centers for
Disease Control, Atlanta, GA, and World Health
Organization, Geneva, Switzerland) and SPSS v8.0
(SPSS Inc., Chicago, IL). Continuous variables in the
text and tables are expressed as mean  standard
error of mean (SEM).
RESULTS
As can be seen in Table 2, the male:female ratio in TB
group was higher than in the TBDM group (P 
0.05). In the TB group male proportion was almost
twice the female proportion (1.9:1), whereas in the
TBDM group there was an almost equal proportion
of men and women (1.1:1). Regarding age, patients in

Table 2 Clinical and laboratory features of tuberculous patients with or without diabetes mellitus*
Sex (male:female)
Age (years)
Evolution of tuberculosis (years)
Evolution of diabetes (years)
Leukocytes (cells/mm3)
Lymphocytes (cells/mm3)
Leukocytes other than lymphocytes (cells/mm3)
* Values correspond to mean  SEM, except for sex, for which the number of patients is indicated, followed in parentheses by the male:female ratio.
TBDM  tuberculosis with diabetes mellitus; TB  tuberculosis (without diabetes mellitus); ns  non-significant; SEM  standard error of mean.
the TB group were significantly younger than the
TBDM patients (P  0.001). The evolution time for
symptoms before the diagnosis of pulmonary tuber-
culosis showed no difference between the groups (~2
years) (P  0.92). In addition, TBDM patients had an
average duration of diabetes of about 8 years.
Although in both groups the average number of
leukocytes and lymphocytes were in the normal
ranges, a lower number of leukocytes was observed in
TBDM patients (P  0.05), mainly due to the lower
number of non-lymphocyte leukocytes (P  0.005).
The presence of a normal chest X-ray film was only
found in one patient (0.8%) from the TB group. Con-
trasting with the usual pattern of pulmonary tubercu-
losis (upper lung field involvement, often with cavi-
tary lesions), diabetic patients frequently developed
different images (Figure 1), as described in the follow-
ing sections.
Tuberculous lesions
The TBDM group had a lower frequency of upper
lung field lesions in comparison with the TB group
(17% vs. 56%, respectively, P  106, Figure 2A),
and a higher frequency of lower lung field lesions
(19% vs. 7%, P  0.01). The combination of upper
and lower lung field lesions was also more frequently
observed in the TBDM group (64%) than in the TB
group (36%, P  104). When all patients with upper
lung field lesions (i.e., joining upper and upper 
lower subgroups from Figure 2A) were pooled
together, the TBDM group had a lower frequency
of such lesions than the TB group (81% vs. 92%,
respectively, P  0.01). Likewise, a higher fre-
quency of pooled lower lesions (by combining the
lower and the upper  lower subgroups) was observed
in the TBDM group than in the TB group (83% vs.
43%, P  106).
As differences other than diabetes per se were
found between both groups of patients, a multiple
regression analysis was carried out in order to clarify
the association of each variable with the development
of lower lung field lesions. This analysis showed that
diabetes mellitus, age and total lymphocyte count
were the only variables included in the regression
model. In this sense, lower lung field lesions were
Atypical images of pulmonary TB in diabetics 457
TBDM group TB group
(n  192) (n  130) P
100:92 (1.1:1) 86:44 (1.9:1) 0.05
51.3  0.9 44.9  1.8 0.001
1.87  0.22 2.18  0.34 ns
8.1  0.52 —
8 836.7  219.5 10 013.1  345.2 0.05
1 974.7  67.6 1 917.4  66.3 ns
6 815.8  221.8 8 095.7  321.9 0.005
more likely to exist in patients with diabetes, increas-
ing age and/or decreasing lymphocyte count. How-
ever,  coefficients demonstrated that diabetes was
almost twice as important as age, and about four
times more important as lymphocytes for the devel-
opment of such lesions (Table 3).
Unilateral (either right or left) lesions in an isolated
upper lung field were more common in the TBDM
patients (82% vs. 52%, P  0.01, Table 4), with a
consequent higher frequency of bilateral lesions in
the TB group. For lower lung field, as well as for
upper  lower lung fields, there were no statistical
differences in the frequency of unilateral/bilateral
lesions in the groups.
Cavitations
Cavitary lung lesions were more often seen in the
TBDM patients (82% vs. TB group 59%, P  104,
Figure 2B). According to the multiple logistic regres-
sion analysis, diabetes mellitus was the only variable
associated with the development of cavitary lesions
(Table 3).
Taking into account all cavitating TBDM patients,
66% had these destructive lesions located in the
upper lung fields, whereas a higher frequency was
observed in the TB patients (88%, P  0.01). The
reverse was true for the involvement of lower lung
fields (29% vs. 3%, respectively, P  104). Similarly
to the results observed with tuberculous lesions, when
all patients with cavities in the upper lung fields (i.e.,
joining upper and upper  lower subgroups from Fig-
ure 2B) were pooled together, the TBDM group had a
lower frequency of cavities in the upper lung fields
than the TB group (71% vs. 97%, respectively, P 
105). In the same way, there was a higher frequency
of lower cavities (i.e., combining lower and upper 
lower subgroups) in the TBDM group than in the TB
group (34% vs. 12%, P  0.001).
With respect to the frequency of unilateral or bilat-
eral cavitations, most of the TBDM patients showed
unilateral cavitations when they were located in the
upper lung fields (97%), while in the TB group cavi-
ties in these lung fields were unilateral in 82% of the
cases (P  0.01, Table 3).
Multiple cavitary lesions at any site of the lung
458 The International Journal of Tuberculosis and Lung Disease

Figure 1 Examples of different chest X-ray patterns in patients with pulmonary tuberculosis. A) Tuberculous patient (without dia-
betes) with lesions in both upper lung fields, with at least two cavities in the upper left side. B) Diabetic tuberculous patient with lesions
involving the upper  lower lung fields and cavities in the upper right side. C and D) Diabetic tuberculous patient with lesions and a
cavity in the left lower lung field. In this patient, the cavity is easily observed over the lower vertebral shadows on the lateral view.

fields were found in one quarter of the TB patients,
while such findings were less commonly observed in
the TBDM group (8%, P  0.01, Table 3).
DISCUSSION
Radiological images of pulmonary tuberculosis have
been described as ‘atypical’ or ‘unusual’ among diabetic
patients, mainly to indicate the presence of lesions in
locations other than the common upper lung regions
seen in reactivation tuberculosis. For example, an
increased frequency of lower lung field involvement
in diabetic patients has been mentioned by some
authors,1,2 along with a higher frequency of multilobar
involvement.4 Additionally, it has also been described
that other features of pulmonary tuberculosis varied
among diabetic people, such as a higher frequency of
cavitary lesions.3–5 Some other studies, however, have
reported no radiological differences between diabetic
and non-diabetic tuberculous patients.6–8 Thus, whether
 Atypical images of pulmonary TB in diabetics 459

Figure 2 Percentage of patients with radiological images of tuberculous lesions (A) or tubercu-
lous cavitations (B), and areas of the lungs where they were located. U  upper lung fields, U 
L  upper and lower lung fields, L  lower lung fields. TB  patients with pulmonary tuberculosis
(without diabetes), TBDM  patients with pulmonary tuberculosis and diabetes mellitus, *P 
0.01, **P  104.

diabetic subjects have an ‘atypical’ image of tubercu-
losis is still controversial.
Our study comprised 192 diabetic tuberculous
patients, which to our knowledge constitutes the larg-
est sample collected in a single study. This allowed us to
draw more confident conclusions, and to better clarify
the controversies about the radiological presentation of
pulmonary tuberculosis among diabetic patients.
In this study we confirmed that a high proportion
(almost two-thirds) of diabetic patients had involve-
ment of combined upper and lower regions of the
lungs, although this pattern was not uncommon
among non-diabetic patients as well (one-third of
them). Nevertheless, the clinical relevance of this dif-
ference might be small, inasmuch as this pattern
includes the classical upper lung involvement of tuber-
culosis, thus making the diagnostic suspicion of this
disease feasible. In relation to the location of the dis-
ease, perhaps the most important change introduced
by diabetes is that up to one-fifth of TBDM patients
developed lesions in the lower lung fields without
affecting the upper lung fields. This radiological image
could mask the diagnosis of tuberculosis, making the
clinician think of diagnostic possibilities other than
tuberculosis, with a consequent delay in the adminis-
tration of proper treatment.
For cavitary lesions perhaps the most striking find-
ing is that a higher proportion of the TBDM patients
(up to 29%) developed cavities in their lower lung fields.
The increased frequency of cavities in this location
strongly determined the higher frequency of cavitation
in TBDM patients as a group, in comparison with the
TB group. Moreover, in our series we observed that cav-
itary lesions in diabetic patients usually affected only
one lung, either right or left, with up to 92% of the
cases developing a single cavity. Therefore, according

Table 3 Contribution of each variable to the presence of cavities and lower lung field lesions according to the logistic regression
analysis after standardization of variables

Lower lung lesions Cavitations

Predictive factor  coefficient Wald test P  coefficient Wald test P
Diabetes mellitus 0.91 50.41 0.0001 0.55 19.03 0.0001
Sex 0.01 0.00 0.96 0.10 0.64 0.42
Age 0.47 14.25 0.0002 0.15 1.51 0.22
Evolution of tuberculosis 0.07 0.39 0.53 0.10 0.76 0.38
Total lymphocytes 0.24 4.04 0.04 0.15 1.55 0.21
Total leukocytes other than lymphocytes 0.22 3.28 0.07 0.13 1.00 0.32
460 The International Journal of Tuberculosis and Lung Disease
Table 4 Unilateral or bilateral involvement of tuberculous lesions and cavitations, as well as number of cavities, in patients
with or without diabetes mellitus
Lesions
TB
Upper lung field(s) 38/35 (52%/48%)*
Upper  lower lung fields 15/32 (32%/68%)
Lower lung field(s) 8/1 (89%/11%)
Single/multiple cavities — —
* All data correspond to number of patients with unilateral/bilateral involvement and their respective percentages in parentheses.
† P  0.01, compared with their respective TB group.
TBDM  tuberculosis with diabetes mellitus; TB  tuberculosis (without diabetes mellitus).
to our results, aside from the ‘classical’ radiological pat-
tern of pulmonary tuberculosis, in patients with diabe-
tes mellitus any lesion appearing in one or both lower
lung fields, with or without a single cavitation, should
also raise the diagnostic possibility of tuberculosis.
The atypical images of pulmonary tuberculosis in
diabetic patients have been vaguely attributed to an
immune abnormality.1 It is known that diabetes mel-
litus causes a decrement in the activity of lymphocytes
and a diminution in the number of monocytes and
macrophages with abnormalities in their chemotactic
and phagocytic activities.10 Moreover, diabetes also
produces dysfunction of polymorphonuclear leuko-
cytes, with a reduction in their bactericidal activ-
ity.11 We found that TBDM patients had a decreased
number of non-lymphocyte leukocytes (a cell popu-
lation mostly composed of polymorphonuclear leu-
kocytes), but logistic regression analysis did not
support their participation in the production of
atypical chest X-rays. By contrast, although we were
unable to find differences in the total number of lym-
phocytes between the TB and TBDM groups, logistic
regression results suggested that lower lymphocyte
counts were associated with the development of lower
lung field lesions. This association, however, was only
true for TB patients, but not for TBDM patients (data
not shown), suggesting that it simply reflects the coin-
cidence of two phenomena occurring with aging: a
normal decline in the lymphocyte count12 and a
progressively increasing frequency of lower lung
lesions in tuberculous patients.9,13 Whilst more
research is needed to clarify the role (if any) of leu-
kocytes, the ‘premature aging’ of the lung induced
by diabetes seems to be the main factor responsible
for the development of the ‘atypical’ radiological pat-
C A D R E : Les études comparatives des aspects radio-
logiques de la tuberculose pulmonaire chez les diabé-
tiques ont donné des résultats divergents.
O B J E C T I F : Apprécier les aspects radiologiques de la
tuberculose pulmonaire dans une grande population de
patients diabétiques.
Cavitations
TBDM TB TBDM
27/6 (82%/18%)† 56/12 (82%/18%) 100/3 (97%/3%)†
60/63 (49%/51%) 1/6 (14%/86%) 5/4 (56%/44%)
25/11 (69%/31%) 2/0 (100%/0%) 44/1 (98%/2%)
58/19 (75%/25%) 144/13 (92%/8%)†
tern in tuberculous diabetic patients, and deserves
further investigation.
References
1 Weaver R A. Unusual radiographic presentation of pulmonary
tuberculosis in diabetic patients. Am Rev Respir Dis 1974;
109: 162–163.
2 Marais R M. Diabetes mellitus in black and coloured tubercu-
losis patients. S Afr Med J 1980; 57: 483–484.
3 Ikezoe J, Takeuchi N, Johkoh T, et al. CT appearance of pul-
monary tuberculosis in diabetic and immunocompromised pa-
tients. Comparison with patients who have no underlying
disease. Am J Roentgenol 1992; 159: 1175–1179.
4 Umut S, Tosun G A, Yildirim N. Radiographic location of pul-
monary tuberculosis in diabetic patients. Chest 1994; 106: 326.
5 Nakamoto A, Saito A. Diagnosis and management of tubercu-
losis in diabetics. Nippon Rinsho 1998; 56: 3205–3208.
6 Morris J T, Seaworth B J, McAllister C K. Pulmonary tubercu-
losis in diabetics. Chest 1992; 102: 539–541.
7 Ghinescu V, Mihaltan F, Chiotan D. Current aspects of the anti-
tubercular chemotherapy of new patients with tuberculosis and
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tol Epidemiol Pneumoftiziol Pneumoftiziol 1989; 38: 115–126.
8 Al-Wabel A H, Teklu B, Mahfouz A A, al-Ghamdi A S, el-Amin
O B, Khan A S. Symptomatology and chest roentgenographic
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M H. Progressive age-related changes in pulmonary tuberculo-
sis images and the effect of diabetes. Am J Respir Crit Care
Med 2000; 162: 1738–1740.
10 Koziel H, Koziel M J. Pulmonary complications of diabetes
mellitus. Infect Dis Clin North Am 1995; 9: 65–66.
11 Repine J E, Clawson C C, Goetz F C. Bactericidal function of
neutrophils from patients with acute bacterial infections and
from diabetics. J Infect Dis 1980; 142: 869–875.
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analytical review. Chest 1999; 116: 961–967.
RÉSUMÉ
S C H É M A : On a revu les radiographies provenant de
patients hospitalisés pour une tuberculose pulmonaire et
un diabète (groupe TBDM, n  192) avec ceux d’un
groupe de patients atteints uniquement de tuberculose
pulmonaire (groupe TB, n  130).
R É S U L T A T S : La durée d’évolution de la tuberculose

était similaire dans les deux groupes (~2 ans). Les dif-
férences statistiques ont été observées comme suit. Les
patients TBDM étaient plus âgés (51,3  0,9 vs. 44,9 
1,8 années, moyenne  erreur standard de la moyenne
[SEM] que ceux du groupe TB). La fréquence des lésions
chez les patients TBDM est plus faible que chez les
patients TB dans les champs supérieurs (17% vs. 56%)
et plus élevée dans les champs inférieurs (19% vs. 7%) et
dans les champs supérieurs et inférieurs (26% vs. 36%).
Les excavations sont plus fréquentes chez les patients
TBDM (82% vs. 59%), surtout dans les champs pulmo-
naires inférieurs (29% vs. 3%). On a observé un plus
grand nombre de cavités multiples chez les patients
TBDM (25% vs. 2%). Le décompte des leucocytes
MARCO DE REFERENCIA : Los estudios comparativos
sobre las imágenes de la tuberculosis pulmonar en suje-
tos diabéticos han arrojado resultados opuestos.
O B J E T I V O : Evaluar las imágenes radiológicas de la
tuberculosis pulmonar en una población grande de
pacientes diabéticos.
D I S E Ñ O : Las radiografías de pacientes hospitalizados
por tuberculosis pulmonar y diabetes (grupo TBDM,
n  192) fueron revisadas y comparadas con las de un
grupo control de sujetos con tuberculosis pulmonar
(grupo TB, n  130).
R E S U L T A D O S : En ambos grupos la tuberculosis pulmo-
nar tuvo un tiempo de evolución similar (~2 años). Las
diferencias estadísticas fueron como sigue. Los pacientes
del grupo TBDM fueron de más edad (51,3  0,9 vs.
grupo TB 44,9  1,8 años, promedio  EE) y sus
lesiones tuberculosas tuvieron una frecuencia menor en
los campos pulmonares superiores (17% vs. 56%), y
mayor en los inferiores (19% vs. 7%) y en los superiores 
Atypical images of pulmonary TB in diabetics 461
totaux est plus bas dans le groupe TBDM (8836,7 
219,5 vs. 10 013,1  345,2 cell/mm3), essentiellement
par suite d’un nombre plus faible de cellules non lym-
phocytaires (681,5  221,8 vs. 8 095,7  321,9 cel-
lules/mm3). Une étude par régression logistique multiple
montre que le fait d’être un sujet diabétique est le facteur
le plus important qui détermine la présence de lésions
dans les champs pulmonaires inférieurs et celle de cavités.
C O N C L U S I O N S : Cette étude portant sur un grand nom-
bre de diabétiques atteints de tuberculose pulmonaire
confirme que les images radiologiques thoraciques sont
significativement différentes de la présentation typique.
Les cliniciens doivent tenir compte de ce fait pour éviter
des erreurs de diagnostic.
RESUMEN
inferiores (64% vs. 36%). Más pacientes del grupo
TBDM desarrollaron cavitaciones (82% vs. 59%), más
comúnmente en los campos pulmonares inferiores (29%
vs. 3%). En pacientes con TBDM se observaron más
cavitaciones múltiples (25% vs. 2%). El grupo TBDM
tuvo una menor recuento total de leucocitos (8.836,7 
219,5 vs. 10.013,1  345,2 células/mm3), principal-
mente debido a un menor número de células no linfocíti-
cas (6.815,8  221,8 vs. 8.095,7  321,9 células/mm3).
La regresión logística múltiple demostró que ser un
sujeto diabético era el principal factor determinante de
la aparición de lesiones en campos pulmonares inferiores
y cavitaciones.
C O N C L U S I O N E S : Este estudio, hecho en una gran can-
tidad de sujetos diabéticos con tuberculosis pulmonar,
confirmó que sus imágenes radiográficas difieren signif-
icativamente de la presentación típica. Los clínicos
deben mantener esto en mente para evitar diagnósticos
equivocados.