Pulmonary cavitations in poorly controlled diabetic patients: is it tuberculosis? – case series of two patients

<p><strong>Background:</strong><span style="font-weight: 400;"> Poorly controlled type 2 diabetes mellitus (T2DM) increases the risk of severe respiratory infections and pulmonary complications, including lung abscesses and cavitary lesions. In tuberculosis-endemic regions, these findings are often initially attributed to tuberculosis, which may delay the diagnosis and management of other relevant infectious etiologies. </span></p> <p><strong>Case Presentation:</strong><span style="font-weight: 400;"> We report a case series of two patients with poorly controlled T2DM who developed pulmonary cavitations in the right upper lung lobe following non-tuberculous infectious processes. The first case involved a 22-year-old woman with a recent dengue infection who developed a cavitary pneumonia without signs of sepsis and showed a favorable clinical course with conservative management using intravenous antibiotics. The second case was a 68-year-old man with T2DM and chronic obstructive pulmonary disease, initially treated for community-acquired pneumonia, who subsequently developed severe diabetic ketoacidosis, septic shock, and extensive pulmonary cavitation, requiring intensive care unit admission, broad-spectrum intravenous antibiotics, and surgical lobectomy. </span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> Pulmonary cavitations in patients with poorly controlled T2DM represent a significant diagnostic and therapeutic challenge, particularly in tuberculosis-endemic settings. This case series underscores the importance of maintaining a high index of suspicion for non-tuberculous etiologies, achieving adequate metabolic control, performing timely imaging studies, and implementing a multidisciplinary approach to prevent adverse outcomes and improve prognosis.</span></p>