Enigma of Extrapulmonary Tuberculosis: Where Do We Stand?

Abstract

Tuberculosis remains a worldwide public health concern. Atypical extrapulmonary presentations may delay its diagnosis and treatment. The present study illustrates the importance of ruling out extrapulmonary tuberculosis in patients presenting with nonspecific symptoms of abdominal diseases. Furthermore, we discuss the variety of clinical presentations, diagnostic challenges, current therapeutic protocols, and prognostic factors associated with extrapulmonary tuberculosis. Early diagnosis and effective treatment may decrease morbidity and mortality in such patients.

Keywords: abdominal involvement; awareness; diagnosis; extrapulmonary tuberculosis; lymphadenopathy; public health; treatment.

Figure 1. CT chest

CT chest revealing right paratracheal, prevascular, subcarinal, and bilateral supraclavicular lymphadenopathy

Figure 2. CT abdomen (transverse section)

CT abdomen showing retrocardiac lymphadenopathy

Figure 3. CT abdomen and pelvis (transverse section)

CT abdomen and pelvis showing left para-aortic and aortocaval lymph node enlargement, measuring 1.2 and 1.4 centimeters in diameter, respectively. Mesenteric or pelvic lymphadenopathy was not present.

Figure 4. MRI abdomen

On MRI abdomen, retroperitoneal and para-aortic lymph nodes appeared enlarged up to 1.3 centimeters. A 1.2-cm para-aortic lymph node was also seen just inferior to the duodenum. No mesenteric lymphadenopathy was present and there was no focal lesion in the pancreas or liver.

Figure 5. Endoscopic ultrasound

Multiple enlarged peri-hepatic and peri-portal lymph nodes were identified on endoscopic ultrasound and a peri-hepatic lymph node was aspirated and biopsied (demarcated by the yellow arrow).

Figure 6. Histopathology

On histopathologic analysis, tuberculous lymphadenitis with extensive necrosis was noted. Granuloma formation was identified (marked by black arrows). Acid-fast staining showed acid-fast bacilli.

Figure 7. Histopathology

Histopathologic examination of the biopsy specimen showed necrotizing tuberculous lymphadenitis with a few giant cells (marked by black arrow). TB lymphadenitis with necrosis was present and rare bacilli were seen upon acid-fast staining.