[The cold tuberculous abscess. A forgotten entity? Considerations based on an autopsy case]

Area of Science:

• Medicine
• Pathology
• Infectious Diseases

Background:

• Tuberculosis (TB) can present with extrapulmonary manifestations.
• Psoas abscesses are a known, though less common, complication of TB.
• HIV-negative individuals can develop severe disseminated TB.

Observation:

• A 28-year-old male without HIV presented with pulmonary and extrapulmonary TB.
• He had a left iliac psoas abscess mimicking a strangulated hernia.
• The patient died from sepsis secondary to colonic perforations.

Findings:

• Autopsy revealed bilateral cavitated TB, Pott disease of the thoracic spine, and tuberculous abscesses in the psoas muscles and thigh.
• Descending colonic perforations were identified.
• Microorganisms identified included Staphylococcus albus, Klebsiella sp, E. coli, anaerobes, and E. histolytica.

Implications:

• This case highlights the diverse and severe presentations of TB, even in HIV-negative patients.
• It underscores the importance of considering TB in the differential diagnosis of abdominal masses and sepsis.
• The polymicrobial nature of the colonic perforation suggests complex infectious dynamics in the context of severe TB.