Reversible cystic lung disease secondary to pulmonary tuberculosis

Pulmonary tuberculosis rarely presents as cystic lung disease, posing a significant diagnostic challenge, particularly in tuberculosis-endemic regions. We report the case of an immunocompetent middle-aged male who presented with fever, dry cough, and progressive respiratory failure. Contrast-enhanced computed tomography demonstrated multiple cysts in both lungs, with associated ground-glass opacities. In addition, necrotic lymphadenopathy and a small pleural collection were present, which led to a presumptive imaging diagnosis of tuberculosis, later confirmed. Follow-up imaging demonstrated significant reversal of cystic changes following antitubercular therapy. This case highlights cystic pulmonary tuberculosis as an important radiological mimic of diffuse cystic lung disease and underscores the potential reversibility of cysts with timely treatment.