The many faces of extrapulmonary tuberculosis: A case series

Extrapulmonary tuberculosis (EPTB) is the clinical entity that is gaining more recognition. Still, it may emerge in various ways, making it difficult to diagnose. Even though pulmonary tuberculosis is the most common variety, EPTB may affect many organ systems and often mimics other diseases, therefore postponing diagnosis, and treatment. Five rare types of EPTB, including testicular tuberculosis, esophageal tuberculosis, psoas abscess with spinal involvement, tuberculous mastitis, and parotid gland tuberculosis, are the main subjects of this case series. All patients who were HIV-negative were diagnosed utilizing clinical examination, imaging studies, histology, and molecular testing using CBNAAT/GeneXpert. Although these instances are unusual, early diagnosis and the initiation of anti-tubercular treatment yielded good results. Requiring second-line treatment, one patient was identified with multidrug-resistant tuberculosis (MDR-TB). In a few cases, surgical intervention was required for the treatment of complications and to confirm the diagnosis. The variety of presentations highlights the importance of maintaining a high index of suspicion for EPTB, particularly in endemic areas. The timeliness of intervention and reduction of disease burden depend on the improved diagnostic modalities and the multidisciplinary approach. This case series highlights the importance of understanding the various presentations of EPTB to prevent delayed treatment and misdiagnosis.