ACTIVE PULMONARY TUBERCULOSIS WITH NEGATIVE TUBERCULIN SKIN REACTIONS

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Abstract
Twelve cases of active pulmonary tuberculosis, proved by culture and/or microscopy, but with repeatedly negative skin tests to PPD [purified protein derivative] are reported. None of the patients was seriously ill or had other disorders commonly associated with false-negative tuberculin skin reactions. By exclusion, skin anergy, either specific or nonspecific, was the causative factor. Four patients had no reaction to mumps antigen despite a positive history of having mumps. Four patients had positive reactions to OT [Old Tuberculin] despite repeatedly negative reactions to PPD (250 TU [tuberculin units]). These were considered as having specific anergy to PPD. All 12 cases were included in this paper as no cause for the falsely negative tuberculin skin reactions was apparent, thus creating a diagnostic problem in each case. Except for the absence of Negroes, no difference in the age, sex, clinical presentation, or hospital course differentiated these 12 from the usual patient of this hospital''s tuberculosis service. The rarity of a false-negative tuberculin skin reaction re-emphasizes the value of PPD in the diagnosis of tuberculosis. However, despite its great value, a negative reaction to PPD (250 TU) does not exclude tuberculosis.[long dash]Authors.

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