Disseminated Tuberculosis With Cutaneous, Cerebrovascular, and Thromboembolic Manifestations in a Young Immunocompetent Male Patient: A Case Report

Tuberculosis (TB) remains a leading infection because of morbidity and mortality worldwide, with extrapulmonary manifestations occurring less commonly among human immunodeficiency virus (HIV) seronegative individuals. We present the case of a 20-year-old Marshallese male patient with a medical history of hypertension, who presented with dysphagia, weight loss, and altered mental status after a fall and was found to have disseminated TB infection involving the lungs, pleura, and skin of the left auricular region. His hospital course was complicated by a large left middle cerebral artery territory ischemic infarct with mild hemorrhagic transformation and a left lower lobe pulmonary embolism. Of note, the patient was HIV seronegative, and his hypercoagulable workup was also unremarkable, thus suggesting a TB-associated hypercoagulable state as the likely mechanism for his thromboembolic complications. Although markedly elevated pleural fluid adenosine deaminase levels and exudative pleural effusion provided strong corroborating evidence for tuberculous pleuritis, negative Mycobacterium tuberculosis complex polymerase chain reaction (PCR) on both bronchoalveolar lavage and serum added to the diagnostic complexity. This case highlights the importance of maintaining a high index of clinical suspicion for disseminated TB and its thromboembolic complications in young patients from high-TB-burden regions, even in the absence of immunosuppression.