Tuberculosis (extrapulmonary and latent) Quiz: Ace Your Exams

A 60-year-old man presents to the primary care clinic for tuberculosis screening before starting a new job as a part-time nurse at a prison. He currently has a right sided headache with photophobia, a cough that he says is no different from his chronic cough, and low back pain. Past medical history includes chronic obstructive pulmonary disease, coronary artery disease, and migraines. Current medications include aspirin, atorvastatin, fluticasone-salmeterol, sumatriptan and verapamil. Temperature is 37.0 ºC (98.6 ºF), pulse is 86/min, blood pressure is 128/83 mmHg, respiratory rate is 16/min, and oxygen saturation is 100% on room air. On physical examination, the patient has a dry cough. He is alert and oriented and there are no focal neurological deficits. There is no nuchal rigidity. Cardiac auscultation is within normal limits. Lung sounds are clear to auscultation. There is tenderness to palpation along the lumbar paravertebral musculature but none along the spinous processes. A serum interferon gamma release assay is positive. Chest radiograph is normal. Which of the following is the most likely diagnosis?