Two cases of cryptogenic organizing pneumonia masquerading as tuberculosis (TB) in a TB endemic area

Before the era of COVID-19 pandemic, organizing pneumonia (OP) is often underdiagnosed while tuberculosis (TB) is overdiagnosed especially in an endemic area. We report two patients with cryptogenic OP mimicking TB. First, a 56-year-old lady with right upper lobe air space opacity and, second, a 37-year-old lady with left upper lobe cavitary lesion. They were treated empirically for pulmonary TB as they had chronic cough with typical chest imaging findings. As there were no improvements despite anti-TB and investigations for TB were negative, they underwent image-guided biopsy which confirmed OP. Both patients received 6 months of corticosteroids therapy and made complete recovery. These cases highlight the rare presentation of OP and serves as a reminder that patients tested negative for TB, despite typical history and chest imaging findings, warrant further investigations as many diseases may mimic TB and vice versa.