Silent pulmonary tuberculosis in patients with poorly controlled diabetes mellitus: Pathogenesis, clinical implications, and diagnostic challenges.

The coexistence of tuberculosis (TB) and diabetes mellitus (DM) presents a significant global health challenge, particularly in patients with poorly controlled glycemic levels. Subclinical or silent pulmonary TB in diabetic individuals-characterized by the absence of classic symptoms-often leads to delayed diagnosis, atypical clinical presentations, and suboptimal treatment outcomes. This review explores the underlying pathogenesis, unique clinical manifestations, and diagnostic and therapeutic challenges in this high-risk population. We highlight the interplay between hyperglycemia and immune dysfunction, the limitations of current diagnostic tools, and the need for tailored management strategies to improve TB control in diabetic patients.