Extensive Multisystemic Disseminated Tuberculosis in an Immunocompetent Patient

Area of Science:

• Infectious Diseases
• Dermatology
• Radiology

Background:

• Extrapulmonary tuberculosis (TB) is infrequently encountered, characterized by subtle onset and minimal bacterial presence.
• Cutaneous manifestations of TB can be diverse and challenging to diagnose.
• Disseminated TB involves multiple organ systems, posing diagnostic difficulties.

Observation:

• A case of disseminated tuberculosis in an immunocompetent adult male is described.
• The patient presented with varied cutaneous lesions, including subcutaneous abscesses and noduloulcerative lesions with discharging sinuses.
• Extensive diagnostic workup revealed widespread TB involvement affecting skin, subcutaneous tissue, lungs, lymph nodes, and multiple skeletal sites (Pott's spine, skull, mandible, ribs, scapula, pelvis), as well as the thyroid.

Findings:

• The case demonstrates a rare presentation of disseminated tuberculosis with extensive extrapulmonary and cutaneous involvement.
• Morphologically distinct skin lesions served as the initial clinical indicator of widespread disease.
• Comprehensive imaging and laboratory investigations were crucial in delineating the full extent of TB dissemination.

Implications:

• This case underscores the importance of considering disseminated tuberculosis in immunocompetent individuals presenting with unusual or multiple cutaneous lesions.
• Early and thorough diagnostic evaluation is critical for identifying extensive extrapulmonary TB and initiating timely treatment.
• The findings emphasize the diagnostic utility of integrating clinical presentation with advanced imaging and histopathological analyses in complex TB cases.