Tuberculosis presenting as multiple intramuscular nodules in a child: a case report

Abstract

IntroductionTuberculosis is a global health problem that mostly affects people in developing countries. Tuberculosis can occur in various organ systems and may present with diverse manifestations in the same system. Primary muscular tuberculosis is a very rare condition in both adults and children, and tuberculosis of various muscle groups presenting as intramuscular nodules is an even more uncommon presentation.Case presentationA 9-year-old Asian girl presented with multiple painless, gradually progressive swellings over different parts of her body for 3 months with no history of contact with tuberculosis. A physical examination was normal except for multiple swellings in her right forearm, a single swelling in her interscapular region and multiple swellings in her right calf. Ultrasonography of swellings revealed multiple nodules in the intramuscular layer. Excisional biopsies performed from two different sites revealed swellings in muscular layers and histopathology showed granulomatous inflammation with caseous necrosis consistent with tuberculosis. The child was started on antitubercular therapy after which the swellings resolved; she was kept on regular follow up.ConclusionsIntramuscular nodules in multiple muscular sites may be the presenting symptoms of tuberculosis of the muscles. Tuberculosis of skeletal muscles should be considered in a differential diagnosis when presented with single or multiple masses even when a chest X-ray is normal and there is no evidence of tubercular foci elsewhere in the body.

Psoas muscle tuberculosis in Greece: report of two cases

“…8 However, multiple locations are not uncommon and occur more often in patients who are immunocompromised, including HIV-infected patients. 7,10 On the contrary, primary tuberculous psoas abscess in a patient without any apparent focus and without any previous predisposing pathology is an extremely rare process.…”

“…4 Actually, the primary type of disease can only be detected in case these have been transplanted to a muscle through an infected needle while performing a thoracentesis or an intramuscular injection. 8 Moreover, quite often muscle tuberculosis is misdiagnosed as sarcoma, soft tissue tumor, fungal infection, parasitic infectious hydatid cyst, lipoma or hematoma. 9 This potential misdiagnosis is the main reason to present our experience with two such cases.…”

Case report: Muscular tuberculosis with lower-extremity muscular masses as the initial presentation: Clinicopathological analysis of two cases and review of the literature

“…PCR for the mycobacterium tuberculosis complex in blood, urine, sputum, and paraffin-embedded samples from case 1 returned negative results; however, the result was positive in frozen sections of muscles. A diagnosis of MT was considered in case 1, despite the fact that all the tests used for diagnosis of TB were negative, with the exceptions of PCR and histopathology ( 5 , 6 ).…”

“…PCR for TB was positive in case 2 in paraffin-embedded and frozen sections of muscles. A diagnosis of MT was considered in case 2, despite the lack of detectable focus of tubercular infection except in the PCR and histopathology results ( 5 , 6 ).…”

Erector Spinae Tubercular Abscess

“…2. Muscle involvement without coexisting active skeletal or extraskeletal tuberculosis is a very rare form of extrapulmonary tuberculosis, which manifests with different presentations such as isolated muscle mass, tubercular myositis, isolated muscular abscess and tubercular pyomyositis [ 5 ]. The rarity of muscle involvement in tuberculosis has been attributed to various reasons such as a high lactic acid concentration, lack of reticuloendothelial/lymphatic tissue, abundant blood supply, and the highly differentiated state of muscle tissue [ 6 ].…”