Case report: extra pulmonary tuberculosis in sickle cell disease.

Area of Science:

• Medicine
• Infectious Diseases
• Immunology

Background:

• Tuberculosis (TB) typically affects the lungs but can manifest as extra-pulmonary tuberculosis (EPTB) in individuals with compromised immune systems.
• Sickle cell anaemia (HBS) is a known risk factor for various infections, potentially increasing susceptibility to EPTB.

Observation:

• A 22-year-old female with HBS presented with a three-month history of bilateral hip pain, weight loss, left hip swelling with discharging sinuses, paraplegia, and recurrent fever.
• Initial investigations revealed leukocytosis, thrombocytosis, elevated ESR (120mm/Hr), and normal retroviral screening. Acid-fast bacilli (AFB) smears were negative.
• Pelvic X-ray showed L4/L5 disc space loss and avascular necrosis of the femoral heads, while chest X-ray was normal.

Findings:

• Bacteriologic cultures from sinuses grew Escherichia coli and Staphylococcus aureus, sensitive to sparfloxacin.
• Despite negative AFB smears, the patient's clinical and hematological parameters improved on an anti-TB regimen, indicating a diagnosis of EPTB.
• A nine-month course of anti-TB therapy was completed, followed by discharge to physiotherapy.

Implications:

• This case underscores the importance of a high index of clinical suspicion for EPTB in patients with underlying conditions like HBS.
• Diagnostic challenges highlight the need for advanced laboratory facilities to accurately diagnose EPTB, particularly when initial smears are negative.
• Effective management of EPTB requires prompt diagnosis and appropriate anti-TB therapy, emphasizing the critical role of well-equipped diagnostic services.