Extrapulmonary Tuberculosis: A Case Series of Diagnostic Challenges and Unusual Presentations from a Tertiary Care Hospital in Pune

Background: Extrapulmonary tuberculosis (EPTB) poses significant diagnostic challenges due to its diverse and often atypical clinical presentations. Case details: This case series from a tertiary care hospital in Pune, India, highlights five distinct EPTB presentations diagnosed between December 2022 and May 2024. The cases include recurrent suprasternal abscess with subsequent cervical lymphadenitis, pulmonary TB extending to cervical lymph nodes, subcutaneous thigh TB, pediatric tibial osteomyelitis, and disseminated mediastinal and cervical lymphadenitis. Diagnostic confirmation relied on ultrasonography, computed tomography (CT), histopathology, Ziehl-Neelsen staining, and cartridge-based nucleic acid amplification testing (CBNAAT), often detecting Mycobacterium tuberculosis (MTB) despite low bacterial loads. All cases received standard drug-sensitive TB (DS-TB) treatment, yielding varied outcomes, ranging from full recovery to recurrence in one instance. Conclusion: These cases underscore the need for heightened clinical suspicion in TB-endemic regions and emphasize the pivotal role of molecular diagnostics in recognizing atypical EPTB presentations. Early diagnosis and comprehensive follow-up are essential for optimizing patient outcomes. KEYWORDS: CBNAAT, Extra-pulmonary tuberculosis, Mycobacterium tuberculosis