Malignant metastatic deposits in an immunocompromised patient—could this be tuberculosis?

We report the case of a 50-year-old female renal transplant patient who developed disseminated deposits initially diagnosed as metastatic malignancy of unknown primary. She declined a tissue diagnosis but subsequently developed recurrent sepsis and symptomatic unilateral pleural effusion. Mycobacterium tuberculosis was cultured from pleural fluid. Following introduction of anti-tuberculous medications, her symptoms improved rapidly and the progression of her disseminated deposits stabilized. Tuberculosis is well-known to be associated with immunocompromised patients. It is a curable disease and should remain an important differential diagnosis for transplant patients who develop suspicious malignant metastatic lesions.