Tuberculosis is an endemic problem through most of the world. However, when it presents as active pulmonary disease in the United States, especially in nonimmigrrant, it is usually early in the disease process. This patient a native resident, had delayed seeking care for months.
The chest radiograph shows massive cavitary lesions, and sputum samples had an overwhelming AFB organism load. The following series of cuts from the CT chest that demonstrates the cavitation predominantly in the upper lobes.
On CT head imaging there was also evidence of tuberculomas.