Pulmonary tuberculosis is the most common cause for cavitary lung disease in India due to its endemic nature and high case burden. In spite of awareness by government organizations regarding symptoms, diagnostic modalities and treatment options for disease, Pulmonary tuberculosis management is delayed in all aspects due to the large proportion of cases receiving access to the private sector where adequate training and awareness regarding tuberculosis is missing. Constitutional symptoms of tuberculosis are not severe and fatal as well and this is the most common reason for lack of timely suspicion as commonly occurred with cardiac ailments. Constitutional symptoms in tuberculosis cases are usually managed by general practitioners in line with enteric fever, jaundice, bronchitis and pneumonia and these cases were treated accordingly. In present case report, 45-year-old female, with constitutional symptoms for six months were treated in outdoor and indoor settings by general practitioners, family physicians and other healthcare professionals with antibiotics and bronchodilators in line with enteric fever, jaundice and bronchitis with asthma on many occasions with partial response to treatment and symptoms worsening. She was referred to our center after an episode of moderate hemoptysis and we have retrospectively studied the reports and noted chronic lung cavitation in chest x-rays done a few months before which is clearly demarcated and visible in posteroanterior and lateral views. Her radiological abnormalities were never evaluated as she was never examined by a pulmonologist before our center and only x-ray was done without a confirmed diagnosis. We have documented typical cavitary lesions favoring chronic infective disease with radiological features of tuberculous cavity in HRCT chest. Her induced sputum examination for CBNAAT (Cartridge based nucleic acid amplification) MTB (mycobacterium tuberculosis) positive, Rifampicin mutation (Rpo-b) Negative. Treatment initiated with anti-tuberculosis (ATT). We have recorded near complete radiological resolution, bacteriological cure after eight months of ATT with good compliance. Pulmonary tuberculosis should be suspected early in cases with cavitating lung disease with constitutional symptoms to have a successful treatment outcome.

Any cancer can spread to the skin, a phenomenon typically more common in advanced stages of the disease. However, some tumors can remain clinically silent until the discovery of a cutaneous metastasis, often complicating the diagnosis of the primary tumor, especially if it's a rare tumor like breast cancer in men. It is in this context that we report a case of localized cutaneous metastasis on the scalp, without the presence of other associated clinical signs. Investigations revealed a metastatic breast carcinoma requiring extensive surgical intervention, complemented by adjuvant treatments.