Late generalized tuberculosis: unusual features of an often overlooked disease

Late generalized tuberculosis--ie, disseminated tuberculosis occurring long after the primary infection-- is an often unrecognized cause of severe illness in patients with relative immunocompromise, such as the elderly, alcoholics, or those with chronic illnesses. It has become increasingly recognized in the elderly as a cause of a gradual debilitating illness, often with vague constitutional symptoms. We describe three cases of late generalized tuberculosis in patients seen on a single medical service over a 6-month period. Each case presents a unique features of extrapulmonary tuberculosis that escaped diagnosis for some time, and each of these elderly patients had a protracted and wasting illness. We present these cases and the ensuing discussion to reemphasize to clinicians that late generalized tuberculosis may be experiencing increased prevalence among the elderly and that diagnosis requires a heightened suspicion. A history of past tuberculosis infection is not always present, but the diagnosis should be entertained in any elderly patient with a chronic debilitating illness.