Case Report: Multiple Metastatic Primary Multidrug-Resistant Tubercular Abscesses

Area of Science:

• Infectious Diseases
• Microbiology
• Dermatology

Background:

• Tuberculosis (TB) typically affects the lungs, but extrapulmonary manifestations can occur.
• Subcutaneous abscesses are an uncommon presentation of TB, posing diagnostic challenges.

Observation:

• A 21-year-old male presented with multiple, persistent subcutaneous swellings on his heels, elbow, and finger base.
• Initial treatment for suspected bacterial abscesses was ineffective, prompting further investigation.

Findings:

• Elevated erythrocyte sedimentation rate and imaging suggestive of osteomyelitis were noted.
• Gene Xpert confirmed multidrug-resistant Mycobacterium tuberculosis as the cause.
• A bedaquiline-based regimen led to a reduction in abscess size.

Implications:

• This case underscores the difficulty in diagnosing atypical, disseminated tuberculosis, particularly with drug-resistant strains.
• Highlights the need for considering TB in unexplained subcutaneous lesions, even without pulmonary symptoms.
• Emphasizes the importance of prompt diagnosis and tailored multidrug-resistant TB treatment strategies for favorable outcomes.