Tubercular Intramuscular Abscess Mimicking Lumbar Hernia: A Rare Case Report

Tuberculosis (TB) is a worldwide health concern. Although pulmonary TB is common, extrapulmonary TB, such as infections of the musculoskeletal system, poses diagnostic challenges. The present report details a case of a tubercular intramuscular abscess in the lumbar region, which clinically resembled a lumbar hernia. The present report focuses on a 53-year-old male patient with a progressive, severe mass in the mid-lower back that had lasted for several months. The initial clinical assessment and radiography suggested a lipoma, sebaceous cyst, or lumbar hernia. An ultrasonographic examination revealed that the mass was heterogeneously hypoechoic with internal echoes that did not correlate with lipomas or sebaceous cysts. Further systemic cytological and histopathological analysis revealed tuberculous alterations, including caseation necrosis, epithelioid granulomas and Langhans giant cells. Surgical exploration revealed an abscess within the extrinsic muscular plane, which was drained successfully. Anti-tubercular Therapy (ATT) was initiated after surgery and resulted in marked improvement of the patient’s symptoms. At the one-year follow-up, the lesion had not recurred, nor were there any associated manifestations of systemic disease. The present case emphasises the importance of considering tubercular aetiology in unusual complaints of lumbar swellings, particularly in TBendemic areas. The diagnostic process, based on imaging and histopathological examination, was instrumental in achieving the correct diagnosis and ruling out mimicking conditions, such as lumbar hernia or fat necrosis. Specifically, the early initiation of ATT, combined with surgical intervention, led to a positive outcome. Reporting such cases is essential to raise awareness and provide clinicians with knowledge about rare extrapulmonary TB.