Disseminated Tuberculosis: A Case of Multiple Spread Mass

Area of Science:

• Infectious Diseases
• Pulmonology
• Radiology

Background:

• Disseminated tuberculosis (TB) presents with diverse symptoms, often delaying diagnosis due to atypical manifestations.
• Mycobacterium tuberculosis (MT) spread via lymphohematogenous routes causes significant morbidity and mortality.
• Standard diagnosis involves identifying MT through biopsy cultures or acid-fast smears.

Observation:

• A 61-year-old male presented with lumbar pain, parasternal and axillary masses, weight loss, anorexia, and asthenia.
• Imaging revealed lumbar fractures, paravertebral lesions, lung masses, mediastinal adenomegaly, and splenic/sternal/scapular lesions.
• Biopsy confirmed Mycobacterium tuberculosis (MT) via nucleic acid amplification (NAA).

Findings:

• The patient initiated four-drug therapy (isoniazid, rifampin, pyrazinamide, ethambutol) for disseminated tuberculosis.
• Bronchofibroscopy showed submucosal infiltration, and bronchial lavage tested positive for MT.
• Histopathology indicated a chronic granulomatous inflammatory process.

Implications:

• The patient is now on a two-drug regimen (isoniazid, rifampin) with observed regression of masses.
• This case highlights the importance of comprehensive diagnostic approaches for disseminated tuberculosis.
• Effective management involves prompt initiation of appropriate multi-drug antibacillary therapy.