Unusual and Uncommon Presentations of Extrapulmonary Tuberculosis: A Case Series

Tuberculosis (TB) is primarily a disease of the lungs; however, Extrapulmonary TB (EPTB) mainly affects the lymph nodes, pleural cavity and spine. Other sites are considered rare and uncommon. Authors present five interesting cases of EPTB from different sites. The first case involved thyroid TB that had spread to the neck. The Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) test was positive. The patient was started on antitubercular treatment and was discharged after undergoing incision and drainage. The second case is of an immunocompetent patient with disseminated TB, which spread from the lungs to the pleura, muscles, subcutaneous tissue and skin, resulting in fistula formation. The CBNAAT was positive, and the Line Probe Assay (LPA) indicated that the strains were sensitive to rifampicin and isoniazid. The third case details a female patient with genital TB who was unable to conceive. An ultrasound examination revealed issues in the adnexa. The CBNAAT was positive (with low levels of Mycobacterium tuberculosis detected, and rifampicin was found to be sensitive), but her sputum sample was negative. The fourth case describes disseminated TB in a seropositive female, where her synovial fluid tested positive and her Computed Tomography (CT) chest findings were suggestive of TB. The fifth case is of abdominal TB in a patient with a history of previous abdominal surgery. Her CBNAAT was positive and she recovered following treatment. In present study, all the cases presented unusual manifestations and the diagnosis was made based on radiological findings combined with microbiological laboratory investigations. Therefore, clinically suspecting these cases and confirming the diagnosis through microbiological tests is critically important.