The False-Positive TB Test That Helped Find My Pneumonia During Chemotherapy
Updated: Sep 2
Why My Primary-Care Doctor Still Mattered While My Oncologist Treated the Cancer
On December 31, 2020, I went to my primary-care doctor asking for a chest X-ray.
I was in the middle of doxorubicin chemotherapy for Stage IV uterine leiomyosarcoma. I had already received my treatment for that three-week period, and I was trying to manage everything cancer had placed into my life.
The reason I asked for the X-ray had nothing to do with symptoms I recognized in myself.
My son was beginning a job at a restaurant and had received a positive tuberculosis screening result. He needed a chest X-ray to determine whether there was evidence of active TB disease.
His X-ray was clear, and we were eventually told that his screening result was a false positive.
That unexpected result led me to ask a question that may have protected me from becoming much sicker.
“Since I am going through chemotherapy and living in the same house, can I have a chest X-ray too?”
My doctor agreed.
The X-ray did not show tuberculosis.
It showed pneumonia.
I Did Not Know I Had Pneumonia
I had asthma long before cancer.
Coughing, wheezing, chest tightness, and breathing changes were not entirely new experiences for me. Because of that, I did not recognize that something different was happening in my lungs.
Pneumonia can cause symptoms such as cough, fever, chills, shortness of breath, fatigue, and chest discomfort. The symptoms can range from mild to severe, and the experience may differ depending on the germ involved, the person’s age, and other health conditions.
My pneumonia was mild.
I do not know exactly how long I had it before the X-ray found it.
I had not gone into the doctor’s office saying:
“I think I have pneumonia.”
I went in because my son’s TB screening made me wonder whether I should also be checked. As a cancer patient, my immune system is weakened. When anyone in the house gets something, I want to prevent it from being severe if I do. To do that, I need to let my doctor know what was happening in my home.
Sometimes the reason a person enters a doctor’s office is not the condition the doctor ultimately finds.
The Last Day Before My Insurance Reset
December 31 had another meaning for me.
I had already reached my health-insurance out-of-pocket maximum for that year.
Because I was receiving chemotherapy, undergoing surgery, managing scans, and attending many appointments, I had already paid the full amount my plan required before covered care became less expensive for the remainder of the year.
The next day was January 1.
My high deductible would begin again.
That meant the same medical test could become much more expensive simply because the calendar changed overnight.
I understood that financial reality, so I asked for the X-ray while I still had the opportunity to receive it without starting another large round of out-of-pocket expenses.
Patients should not have to calculate medical decisions around the final hours of an insurance year.
But many of us do.
My Doctor Granted an Unusual Request
My primary-care doctor could have told me that I had no reason to be tested.
She could have said that my son was already receiving the proper follow-up and that I should wait for symptoms.
Instead, she considered the larger picture.
I was receiving chemotherapy.
I had asthma.
Someone in my household had received a positive TB screening result.
I was concerned.
She agreed to order the chest X-ray.
That willingness to listen mattered.
The test did not reveal what either of us expected.
It found something else that needed treatment.
A Positive TB Screening Does Not Always Mean Active Disease
A positive TB skin or blood test usually means a person may have been infected with tuberculosis bacteria. It does not, by itself, prove that the person has active, contagious TB disease.
The CDC explains that additional evaluation, often including a chest X-ray, is used to look for active disease. A person with inactive, or latent, TB may have a positive screening result with a normal chest X-ray and no symptoms. False-positive screening results can also occur under certain circumstances.
My son’s chest X-ray was clear.
The important point in my story is not the technical reason his screening test was positive.
The important point is that his result caused me to ask for my own X-ray.
His unexpected medical detour helped uncover my pneumonia.
Chemotherapy Changes the Meaning of an Infection
Pneumonia is serious for anyone.
During chemotherapy, infection may become more dangerous because some treatments reduce white blood cells, including neutrophils that help the body fight infection.
The National Cancer Institute warns that cancer treatment can increase infection risk and advises patients to contact their medical teams promptly about possible signs of infection.
I was fortunate.
My pneumonia was mild enough to be treated outside the hospital.
My doctor prescribed a course of antibiotics.
I was not admitted.
I was able to remain at home and continue being monitored.
That outcome should not be used to suggest that pneumonia during chemotherapy is always mild or safe to manage at home.
Another patient may need emergency care or hospitalization.
I Had Received a Pneumococcal Vaccine
Before this happened, I had received what I called the pneumonia shot.
The more precise name is a "pneumococcal vaccine".
Pneumococcal vaccines help protect against disease caused by certain strains of "Streptococcus pneumoniae", a bacterium that can cause pneumonia and other serious infections.
They do not prevent every form of pneumonia because pneumonia may also be caused by other bacteria, viruses, fungi, or other processes.
My doctor reminded me that vaccines help prepare the immune system to recognize and fight certain germs.
I already understood that principle, but hearing it after the diagnosis made me even more grateful that I had been vaccinated.
I cannot prove that the vaccine was the reason my illness remained mild. We did not establish in this story exactly which organism caused my pneumonia.
I can say that I was glad I had followed the vaccination advice given to me.
CDC guidance recommends that many people with cancer or other immune-compromising conditions remain current on pneumococcal vaccination based on their age, health conditions, previous vaccines, and clinician recommendations.
A Vaccine Is Protection, Not a Guarantee
This experience helped reinforce something patients sometimes misunderstand.
A vaccine is not an invisible wall that guarantees a person will never become sick.
It helps train the immune system against particular organisms or forms of disease.
Depending on the vaccine, it may reduce the chance of infection, serious illness, complications, hospitalization, or death.
A vaccinated person may still become ill.
That does not automatically mean the vaccine failed.
The illness may be caused by a strain or organism the vaccine does not cover. The immune response may differ from person to person. Cancer treatment may also affect how strongly a patient responds.
Vaccination decisions during cancer care should be made with the oncology and primary-care teams because the correct type and timing may depend on the treatment.
My Oncologist Treated the Cancer
During this period, my cancer doctors were focused on uterine leiomyosarcoma.
They managed:
Doxorubicin chemotherapy
Cancer imaging
Surgical recovery
Port care
Blood counts connected to treatment
Cancer response
Treatment side effects
The possibility of recurrence
That work was essential.
But cancer was not the only thing happening inside my body.
I still had asthma.
I could still develop pneumonia.
I still needed vaccinations.
I still needed my iron checked.
I still needed ordinary medical care.
That was why I continued seeing my primary-care doctor.
My Primary-Care Doctor Treated the Whole Person
I thought of the roles this way:
I went to my cancer doctor for all things cancer. I went to my primary-care doctor for all things health and medical.
The lines were not always perfectly separate.
My primary-care doctor needed to know what chemotherapy I was receiving.
My oncologist needed to know when I developed pneumonia or began antibiotics.
Both sides needed access to current bloodwork and medication information.
But keeping primary care involved made sure someone was still looking at the rest of my body.
Cancer treatment can become so large that it blocks the view of everything else.
A patient may believe every symptom belongs to chemotherapy.
A doctor may assume oncology is handling every problem.
Important conditions can be missed when no one is clearly responsible for whole-person care.
Asthma Made the Pneumonia Harder for Me to Recognize
Before cancer, I already knew what breathing difficulty and chest symptoms felt like.
That familiarity did not necessarily protect me.
It may have made it easier to explain away a new problem as more of the same.
I could think:
My asthma is acting up.
The weather is affecting me.
I am tired from chemotherapy.
The cough is not serious.
My breathing always changes sometimes.
Pneumonia symptoms can overlap with asthma, respiratory infections, treatment effects, anemia, heart problems, and other conditions.
A person with an existing illness still needs to pay attention when a familiar symptom changes in severity, duration, pattern, or response to usual treatment.
Cancer Patients Can Get Pneumonia During Chemotherapy
My story is not telling patients with asthma to request a chest X-ray every time they cough.
It is telling patients to communicate.
During chemotherapy, contact the appropriate medical team about symptoms such as:
Fever
Chills
New or worsening cough
Shortness of breath
Chest pain
Unusual weakness
Confusion
Symptoms that do not respond as expected
Significant changes from the patient’s normal asthma or lung condition
A doctor may decide that the symptoms need examination, laboratory testing, imaging, or another form of evaluation.
The patient’s job is not to know the diagnosis before calling.
The patient’s job is to notice that something has changed.
Chemotherapy Was Affecting My Nutrition Too
The pneumonia was not the only health issue my primary-care doctor was watching.
Chemotherapy changed the way food tasted.
Foods I normally enjoyed could taste strange, metallic, bitter, or simply unpleasant.
I often did not feel like eating.
But my body still needed calories, protein, iron, vitamins, minerals, and fluids.
Cancer treatment can cause nausea, appetite changes, taste changes, fatigue, and other problems that make nutrition difficult. The National Cancer Institute advises patients to work with their healthcare teams when side effects interfere with eating and maintaining strength.
I had to eat even when food gave me no pleasure.
I Used My Bloodwork to Help Guide What I Ate
My doctors were checking my blood.
They looked at iron and other measures connected to health and treatment.
When laboratory results showed that something was low, I tried to include foods containing that nutrient.
I did not use food as a replacement for medical treatment or prescribed supplements.
I used the information to support what my doctors were already doing.
Chemotherapy was depleting my body.
I tried to put things back.
That became my practical approach:
Look at what the bloodwork says my body is lacking, then find manageable ways to add some of it through food when appropriate.
Food Did Not Have to Be a Full Meal
Large meals were not always appealing.
Sometimes the idea of sitting down with a full plate felt overwhelming.
I kept homemade high-iron trail mix around the house.
Several times during the day, I would grab a handful.
That small amount was easier to manage than forcing myself through a large meal.
Depending on what I had available and what fit my medical needs, a trail mix could include ingredients such as nuts, seeds, fortified cereal, or dried fruit.
Patients must consider their own needs, including blood sugar, food safety, allergies, kidney issues, swallowing difficulties, and instructions from the oncology team.
What worked for me may not be appropriate for everyone.
I Did Not Like Protein Shakes
People often recommended protein shakes.
At the time, I did not like them.
The taste and texture did not work for me, especially while chemotherapy had already changed the way food tasted.
Today, there are more flavors, formulas, and ready-to-drink choices than I remember having then.
Still, telling a cancer patient to “just drink a protein shake” may not solve the problem.
The patient may dislike it.
It may worsen nausea.
It may be too sweet.
It may affect blood sugar.
It may contain ingredients that do not fit another medical condition.
The best nutritional solution is one the patient can tolerate and the healthcare team considers safe.
I Ate Because My Body Needed Fuel
Eating during chemotherapy was not always enjoyable.
Sometimes it felt like another treatment.
I ate because my body needed something to work with.
It needed resources to:
Recover from chemotherapy
Heal surgical wounds
Produce blood cells
Fight infection
Maintain muscle
Support energy
Continue treatment
I did not eat perfectly.
I ate what I could.
I looked for small, practical ways to keep nutrients available.
Bloodwork Was More Than Numbers
Cancer patients receive a great deal of laboratory information.
It can begin to feel like a collection of numbers that determine whether treatment happens that day.
For me, the bloodwork also became information about how the rest of my body was coping.
It could show concerns involving:
Red blood cells
Hemoglobin
White blood cells
Neutrophils
Platelets
Iron
Kidney function
Liver function
Electrolytes
Other health measures
The exact tests and desired ranges depend on the patient and treatment.
I learned to ask what the numbers meant and what action, if any, I should take.
My Primary-Care Doctor and Oncologist Needed to Communicate
The discovery of pneumonia was not information that could remain only in my primary-care chart.
My oncology team needed to know that I had an active infection and was taking antibiotics.
Chemotherapy timing may sometimes be affected by infection, fever, blood counts, or how sick the patient is.
I should not make that decision myself.
The primary-care doctor could treat the pneumonia, while oncology determined what the infection meant for the cancer-treatment schedule.
That is collaborative care.
Cancer Does Not Cancel Ordinary Illness
When cancer becomes the biggest problem in a person’s life, every other condition can seem small.
Pneumonia was not small.
Asthma was not small.
Vitamin and iron deficiencies were not small.
They affected whether I could remain healthy enough to continue fighting cancer.
The goal was not merely to attack the tumor.
The goal was to keep the patient alive through the treatment.
The Strange Chain of Events Still Amazes Me
My son needed a TB screening for a restaurant job.
The screening came back positive.
He needed a chest X-ray.
His lungs were clear.
I became concerned because we lived together and I was receiving chemotherapy.
It was December 31.
I had already reached my insurance out-of-pocket maximum.
I asked my primary-care doctor for a chest X-ray.
She agreed.
I did not have TB.
I had pneumonia.
There are times when one unexpected event sends us toward an answer we were not looking for.
I Am Grateful My Doctor Listened
My request was unusual.
I was not presenting with a clear statement that I had been exposed to active TB.
I was worried, receiving chemotherapy, and trying to protect myself.
My doctor could have brushed me off.
Instead, she listened.
The result justified the decision to look more closely.
Not every patient request should automatically lead to a test.
But patients deserve to explain why they are worried, especially when chemotherapy changes their risk.
I Am Grateful for My Son’s Clear X-Ray
I did not want my son to have TB.
I was relieved that his chest imaging was clear.
His positive screening created stress and uncertainty.
It also triggered the chain of events that led to my diagnosis.
I can be grateful that his result did not lead to active TB and grateful that it caused me to ask for help.
I Am Grateful I Had Been Vaccinated
I was glad that I had received pneumococcal vaccination based on my doctor’s recommendations.
I cannot claim it prevented all danger.
I cannot prove how severe the pneumonia would have become without it.
I can say that I believe in using medically appropriate prevention while also understanding that prevention is not a guarantee.
Vaccination, screening, early evaluation, antibiotics, bloodwork, food, and communication all played different roles.
The Financial Part Should Not Be Ignored
I asked for the X-ray on December 31 partly because of my health.
I also asked because I understood my insurance.
The following day, my deductible would reset.
That kind of calculation is common for patients managing expensive illnesses.
People may delay tests, schedule procedures before year-end, postpone treatment until insurance approval, or worry about whether they can afford the next step.
I was fortunate that the test was covered under the year in which I had already reached my maximum.
No patient should feel ashamed for understanding and using her insurance benefits wisely.
Questions to Ask During Chemotherapy
Which symptoms should I report immediately?
Who should I call after business hours?
What temperature counts as a fever for me?
Could my treatment reduce my white blood cells?
Are there vaccines I should receive before, during, or after treatment?
Are any vaccines unsafe during my treatment?
Should I continue seeing my primary-care doctor?
Which doctor should manage infections?
What should I do if asthma or another chronic condition worsens?
Should an infection affect my chemotherapy schedule?
Which blood levels are being monitored?
Would a dietitian help with eating problems?
Which supplements are safe with my cancer medicines?
Questions to Ask About Vaccination
Which pneumococcal vaccine is recommended for me?
Have I already completed the appropriate series?
Does my age or cancer treatment change the recommendation?
When should the vaccine be given in relation to chemotherapy?
Which vaccines are non-live?
Are there vaccines I should avoid?
Should household members also remain current on vaccines?
What symptoms after vaccination require medical advice?
Vaccine recommendations change over time and differ according to age, health history, previous doses, and cancer treatment.
The medical team should determine the appropriate schedule.
Questions to Ask When Food Tastes Bad
Could chemotherapy be changing my sense of taste?
Do my medicines cause nausea or dry mouth?
Am I losing too much weight?
Are my iron or vitamin levels low?
Do I need a dietitian?
Are small meals or snacks appropriate?
Which high-protein foods might be easier to tolerate?
Are protein drinks safe for my blood sugar and kidneys?
Do I need prescribed supplements?
Are there food-safety restrictions during chemotherapy?
What I Wish Someone Had Told Me
I wish someone had told me that pneumonia might not feel obvious while I was receiving chemotherapy.
I wish I had known that my asthma could make me misread the early symptoms.
I wish someone had explained that my primary-care doctor would remain just as important after I received an oncologist.
I wish patients did not have to plan diagnostic tests around the final day before an insurance deductible reset.
I wish someone had told me that food might taste so bad that eating would feel like another medical task.
I wish I had known that small handfuls of food throughout the day could sometimes feel more manageable than a full meal.
Most of all, I wish every cancer patient were told:
“Your oncologist treats the cancer, but someone still needs to care for the rest of your body.”
Hope for Today
My son’s TB screening frightened us.
His chest X-ray was clear.
My own X-ray found pneumonia.
I had not recognized it because the symptoms blended into asthma, chemotherapy, fatigue, and everything else happening in my body.
My primary-care doctor listened to an unusual request.
She ordered the test.
She prescribed antibiotics.
She checked my blood and continued watching my overall health.
I did not need hospitalization.
I was able to recover at home.
I was glad I had received the recommended pneumococcal vaccination, even though no vaccine prevents every kind of pneumonia.
I was glad I understood my insurance well enough to ask for the test before the new deductible year began.
I was even grateful for the strange false alarm that started the whole chain of events.
Cancer care is made of more than dramatic surgeries and chemotherapy infusions.
Sometimes survival depends on an ordinary appointment with a doctor who knows the rest of your health history.
Sometimes it depends on a chest X-ray you almost did not request.
Sometimes it depends on eating a handful of trail mix even though nothing tastes good.
Sometimes it depends on treating the infection so the body can remain strong enough to continue treating the cancer.
Frequently Asked Questions
Can chemotherapy increase infection risk?
Yes. Some chemotherapy lowers infection-fighting white blood cells, which can make infections more serious. The degree and timing of the risk depend on the treatment and patient.
Does a positive TB screening test prove active tuberculosis?
No. Additional evaluation, often including a chest X-ray, is needed to determine whether active TB disease is present.
Can a person have a positive TB screening with a normal chest X-ray?
This can occur with inactive TB infection, and false-positive screening results may also occur in some circumstances. Medical professionals must interpret the complete evaluation.
Can someone still develop pneumonia after receiving a pneumococcal vaccine?
Yes. Pneumonia has many possible causes, and pneumococcal vaccines protect against certain pneumococcal bacteria rather than every cause of pneumonia.
Does the pneumococcal vaccine guarantee that pneumonia will be mild?
No. Vaccination reduces certain risks but cannot predict the severity of every infection in every patient.
Should all cancer patients receive the same pneumococcal vaccine?
No. Recommendations depend on age, medical conditions, treatment, immune status, and previous vaccination. Patients should ask their healthcare professionals what applies to them.
Why did I continue seeing primary care during cancer treatment?
My primary-care doctor managed asthma, infections, blood levels, preventive care, and my general health while oncology concentrated on the cancer and its treatment.
Can asthma make pneumonia harder to recognize?
Symptoms may overlap, including cough, wheezing, chest tightness, and shortness of breath. New, severe, persistent, or changing symptoms require medical evaluation.
Why was nutrition difficult during chemotherapy?
Chemotherapy can cause nausea, appetite loss, fatigue, and changes in taste or smell. These effects may make eating difficult even when the body needs additional support.
Should patients treat vitamin or iron deficiencies with food alone?
Not necessarily. Laboratory findings should be reviewed by healthcare professionals. Some deficiencies require prescribed supplements, medicines, or other treatment. Food may support the medical plan but should not replace it without professional guidance.
Support on Your Journey
An infection during chemotherapy can be frightening, especially when its symptoms resemble a condition you already have.
Surviving Life Lessons Community Groups are being formed so cancer patients, survivors, and caregivers can discuss treatment, infections, nutrition, vaccinations, insurance costs, and the importance of whole-person care.
Your cancer doctor may be fighting the tumor.
You still deserve someone who is watching the rest of you.
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References
Centers for Disease Control and Prevention. “About Pneumococcal Disease.”
Centers for Disease Control and Prevention. “Recommended Vaccines for Adults.”
Centers for Disease Control and Prevention. “Summary of Risk-Based Pneumococcal Vaccination Recommendations.”
Centers for Disease Control and Prevention. “Flu and Cancer.”
Centers for Disease Control and Prevention. “About Pneumonia.”
Centers for Disease Control and Prevention. “Clinical Testing and Diagnosis for Tuberculosis.”
Centers for Disease Control and Prevention. “Clinical Overview of Latent Tuberculosis Infection.”
National Cancer Institute. “Infection and Neutropenia During Cancer Treatment.”
National Cancer Institute. “Eating Hints: Before, During, and After Cancer Treatment.”
MedlinePlus. “Pneumonia.”
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