Masked invaders: A case series on uncommon manifestations of extrapulmonary tuberculosis

ABSTRACT Extrapulmonary tuberculosis (EPTB) is a challenging clinical entity due to its diverse and often atypical presentations. This case series discusses five rare manifestations of EPTB: tubercular arthritis of the wrist, sternoclavicular joint tuberculosis, mandibular osteomyelitis, epididymo-orchitis with scrotal abscess, and tuberculosis-associated Tolosa-Hunt syndrome. All patients were immunocompetent and did not exhibit typical systemic symptoms. Diagnosis was established through a combination of imaging, histopathology, and molecular testing (CBNAAT/GeneXpert). The cases were successfully managed with anti-tubercular therapy (ATT), resulting in favourable outcomes. This report emphasises the necessity for high clinical suspicion, especially in endemic areas, and highlights EPTB’s ability to mimic more common inflammatory or neoplastic conditions.