A rare case of disseminated tuberculosis presenting as multiple visceral abscesses: retropharyngeal abscess, epidural abscess, pulmonary Koch’s, hepatic granuloma and splenic abscess

Abstract

Extrapulmonary TB can present with plethora of clinical signs and symptoms, the spectrum of which remains boundless. Retropharyngeal abscess, epidural abscess, splenic abscess, hepatic granuloma are rare presentations of extrapulmonary TB which requires paramount clinical expertise for diagnosis and timely management thereby preventing dangerous complications. Here is a case report of a 6 year old boy presenting with 2 months history of fever, neck pain and swelling, difficulty in swallowing solid food, restricted neck movements, weight loss and family history of TB contact. Examination revealed bilateral jugulodigastric (level I and II) cervical lymphadenopathy (around 2×2 cm), neck rigidity and a paramedian bulge over posterior pharyngeal wall (measuring 3×3 cm), the inferior extent of which was difficult to visualize on oral cavity examination. Patient was worked up keeping in mind the high possibility of TB, radiography and ultrasonography of neck confirmed the presence of retropharyngeal abscess. CECT neck, chest and abdomen was done to find the extent of lesion and to look any other evidence of tuberculosis which revealed presence of retropharyngeal abscess, epidural abscess, pulmonary Koch’s, hepatic granuloma and splenic abscess with features s/o tuberculosis. He was started on ATT on clinico-radiological basis, his abscess was drained and cheesy material and pus were sent for microbiological and histo-pathological examination, although microbiological evidence was non-contributory, histopathology confirmed tuberculous retropharyngeal abscess. This case reporting was done to elicit the rare presentation of EPTB and the need of high degree of clinical suspicion for early diagnosis and timely treatment to prevent future complications.