Advertisement

Central European Journal of Medicine

, Volume 9, Issue 1, pp 144–147 | Cite as

Disseminated tuberculosis in an immunocompetent patient

  • Sangeetha RanganathEmail author
  • Benjamin Wilson
  • Aarthi Narasimhan
  • John K. Midturi
Research Article
  • 67 Downloads

Abstract

A 53-year-old immigrant male patient presented with left scrotal swelling with a draining ulcer on the left hemiscrotum. Patient had intentional weight loss, fever and night sweats, cough, headaches, confusion and difficulty with ambulation. Imaging studies revealed innumerable pulmonary nodules, leptomeningeal enhancement of the brain and bilateral epididymo-orchitis. Acid fast bacilli (AFB) smear was positive from the surgical specimen of bilateral epididymis and left testes. Cerebrospinal fluid (CSF) analysis revealed neutrophilic predominant pleocytosis with low glucose and elevated protein. Polymerase chain reaction (PCR) test performed on the CSF and AFB smear of epididymis was positive for Mycobacterium tuberculosis. Though the CSF and sputum AFB smears were negative, cultures subsequently grew mycobacterium tuberculosis. Patient was diagnosed with disseminated tuberculosis. Human deficiency virus test was negative. Patient was successfully treated with anti-tuberculosis therapy. Steroid was used as adjuvant therapy due to presence of tuberculous meningitis.

Keywords

Disseminated tuberculosis Tuberculous meningitis Urogenital tuberculosis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. [1]
    Charfi MR, Dougui MH, Louzir B, Mestiri A, Zbiba M, Belalgia MS, et al. Disseminated tuberculosis in non-immunocompromised host: three case reports. Rev Med Interne. 1998 Dec; 19(12):917–920PubMedCrossRefGoogle Scholar
  2. [2]
    Seif F, Armitage K, Petrozzi M. Unusual presentation of a common disease: disseminated tuberculosis in an immunocompetent patient. Am J med 2010; 2010 Sep;123(9):e5–e7. doi: 10.1016/j.amjmed.2010.01.021Google Scholar
  3. [3]
    Kishore PV, Palaian S, Paudel R, Prabhu M, Van den Ende J. Diagnostic Delay in a Multi-Organ Tuberculosis Immunocompetent Patient: A Case Report. Southeast Asian J Trop Med Public Health. 2007 May;38(3):507–511PubMedGoogle Scholar
  4. [4]
    Phypers M, Harris T, Power C. CNS tuberculosis: a longitudinal analysis of epidemiological and clinical features. Int J Tuberc Lung Dis. 2006 Jan;10(1):99–103PubMedGoogle Scholar
  5. [5]
    Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: Pathogenesis and clinical aspects. Clin Microbiol Rev. 2008 Apr;21(2):243–261, table of contents. doi: 10.1128/CMR.00042-07PubMedCentralPubMedCrossRefGoogle Scholar
  6. [6]
    Donald PR, Schoeman JF. Tuberculous Meningitis. N Engl J Med. 2004 Oct 21;351(17):1719–1720CrossRefGoogle Scholar
  7. [7]
    Daikos GL, Cleary T, Rodriguez A, Fischl MA. Multidrug-resistant tuberculous meningitis in patients with AIDS. Int J Tuberc Lung Dis. 2003 Apr;7(4):394–398PubMedGoogle Scholar
  8. [8]
    Nelson CA, Zunt JR. Tuberculosis of the central nervous system in immunocompromised patients: HIV infection and solid organ transplant recipients. Clin Infect Dis. 2011 Nov;53(9):915–926. doi: 10.1093/cid/cir508. Epub 2011 Sep 29PubMedCrossRefGoogle Scholar
  9. [9]
    Shenoy VP, Viswanath S, D’Souza A, Bairy I, Thomas J. Isolated epididymo-orchitis is an unusual presentation of tuberculosis. J Infect Dev Ctries. 2012 Jan 12;6(1):92–94PubMedCrossRefGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sangeetha Ranganath
    • 1
    Email author
  • Benjamin Wilson
    • 2
  • Aarthi Narasimhan
    • 1
  • John K. Midturi
    • 1
  1. 1.Division of Infectious DiseasesScott and White Memorial HospitalTempleUSA
  2. 2.Department of Internal MedicineScott and White Memorial HospitalTempleUSA

Personalised recommendations