Unusual Presentations of Tuberculosis: A Case Series

Abstract

Introduction: Tuberculosis (TB) is an airborne infection caused by the organism Mycobacterium Tuberculosis that can affect any organ though it commonly involves infection of the lungs. Given the nature of Extra-Pulmonary Tuberculosis (EPTB) that has various form of clinical manifestation, diagnosing EPTB remains a challenge. Background: This report discusses three cases of EPTB that posed diagnostic and management challenges. The first case presented as pleural effusion and TB was diagnosed on pleural biopsy. The second case presented with abdominal pain and mass in the right iliac fossa. Final diagnosis of tuberculous colitis was made post-laparotomy and he underwent successful anti-tuberculous treatment. The third case presented with a single enlarged cervical lymph node and a typical history. Investigations were suggestive of tuberculous lymphadenitis and patient showed a positive response to anti-tuberculous treatment. Conclusion: EPTB has various forms of clinical manifestation, which imposes diagnostic and treatment challenges. Thus, it is crucial to always include tuberculosis as part of working diagnosis especially in regions where tuberculosis is endemic until proven otherwise. Hence it is imperative to start treatment early to ensure better response.

Unveiling the Threat: Case Reports of Extra-Pulmonary Tuberculosis among Sanctuary Chimpanzees

“…While the prevalence of TB lymphadenitis in chimpanzees remains unknown, our case series aligns with the disease manifestation in humans, where cervical lymphadenitis is the predominant EPTB manifestation in young individuals. Cervical TB lymphadenitis may manifest as unilateral or multiple masses, often non-tender and slow-growing over weeks to months, with fistula formation observed in up to 10% of human cases [31], a feature frequently noted in our case series.…”

“…TB lymphadenitis emerges as the most prevalent manifestation of EPTB, with cervical nodes being the primary site in humans and non-human primates, along with involvement of inguinal, mesenteric, and mediastinal nodes [34]. Representing approximately 35% of global EPTB cases in humans, cervical LN are the most common site, accounting for 60% to 90% of these cases [31]. While the prevalence of TB lymphadenitis in chimpanzees remains unknown, our case series aligns with the disease manifestation in humans, where cervical lymphadenitis is the predominant EPTB manifestation in young individuals.…”

“…provoking a delayed hypersensitivity reaction, leading to hyperemia, swelling, necrosis, and caseation in the center of the lymph node[31]. This progression was distinctly observed three weeks after the ITST in C3.…”

Tuberculosis in children presenting with chylothorax - Report of two cases and review of the literature

“…Globally, it is estimated that up to 250,000 children die of TB each year and a million are infected [1]. Primary tuberculosis in children most commonly presents with pulmonary disease in the form of pneumonia, lymph node disease and/or pleural effusion [3,4]. Pleural involvement in childhood pulmonary TB may occur either as primary or reactivation disease with incidence as high as 20–30% in high-burden TB settings [[5], [6], [7], [8], [9]], and higher with HIV-TB co-infection [[10], [11], [12]].…”