An apparently healthy young man with a peculiar-looking chest radiograph.

| Canadian Family Physician • Le Médecin de famille canadien 311 This article has been peer reviewed. Cet article a fait l’objet d’une révision par des pairs. Can Fam Physician 2011;57:311-3 key points Owing primarily to the HIV pandemic, the incidence of pulmonary tuberculosis is increasing in both developing and developed nations. Consequently, family physicians are increasingly encountering patients with atypical manifestations of pulmonary tuberculosis. Chest radiographic findings make the diagnosis of tuberculosis easy; however, a peculiar-looking chest x-ray scan in a patient with nonspecific symptoms can pose a problem even for the most discerning family physicians. The family physician in this case report encountered an HIV-positive patient who had no specific symptoms but whose chest radiograph revealed an S-shaped opacity. This case report highlights that HIV-positive patients commonly have atypical presentations of pulmonary tuberculosis, especially if they have low immune status.