According to Subramaniam and Madangopalan,¹ tuberculosis is a very common coincidental lesion in patients having an amoebic liver abscess. It has also been reported that pulmonary tuberculosis can flare up when it is present in a patient who develops pleuropulmonary amoebiasis.²
We have seen a few cases of pulmonary tuberculosis incidentally detected while investigating an amoebic liver abscess (Fig. 24). In our experience, there is no flare up of tuberculous infection. It is possible that the modern antibiotics have changed the picture.
The importance of a shadow seen on X-ray chest is that the clinician might attribute the whole illness to tuberculosis and may stop looking out for an amoebic liver abscess as the cause of illness. This may prove dangerous for the patient, since the diagnosis will then be delayed. Also in endemic regions, pleuropulmonary amoebiasis becomes a close differential diagnosis of tuberculosis.

References

1. Subramaniam, R. and Madangopalan, N. Amoebiasis, Sandoz's Monograph, 1970.
2. Langstone, H T. and Fox, R T. Arch Surg, 1947, 55, 618