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. 2018 Aug 28;18(1):426.
doi: 10.1186/s12879-018-3349-5.

Delayed diagnosis of extrapulmonary tuberculosis presenting as fever of unknown origin in an intermediate-burden country

Jeong-Han Kim  1   2 , Eu Suk Kim  2 , Kang-Il Jun  2 , Hyun Gul Jung  2 , Ji Hwan Bang  1   2 , Pyeong Gyun Choe  2 , Wan Beom Park  2 , Kyoung-Ho Song  2 , Hong Bin Kim  2 , Nam Joong Kim  2 , Myoung-Don Oh  2 , Sang-Won Park  3   4
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Delayed diagnosis of extrapulmonary tuberculosis presenting as fever of unknown origin in an intermediate-burden country

Jeong-Han Kim et al. BMC Infect Dis. .

Abstract

Background: Tuberculosis (TB), especially extrapulmonary tuberculosis (EPTB), is an important cause of fever of unknown origin (FUO) in TB-burdened areas. Little information is known about patients with EPTB with clinical features presenting as FUO and about the factor of delaying the diagnosis.

Methods: We retrospectively analyzed EPTB patients who were referred with FUO at 3 university-affiliated hospitals over 8 years (2010-2017). The subjects were assigned to groups of early diagnosis and delayed diagnosis within 3 days of an initial comprehensive evaluation from the referral. Clinical and laboratory variables were compared between the groups.

Results: A total of 95 patients with febrile EPTB were included. Localizing symptoms and/or signs suggestive of anatomy were identified in 62.1% of the patients. Concurrent lung involvement by TB was presented by 49.5% (47/95) of the patients, and only 23.4% of them showed typical findings of pulmonary TB on simple chest X-ray. Most of the patients showed abnormal lesions on cross-sectional CT (98.9%) and MRI (100%). The clinical variables and blood test results of patients were not significantly different between the two groups. The less typical imaging finding of EPTB on CT (38.5% vs. 79.0%) and MRI (37.5% vs. 79.0%) in the delayed diagnosis group was a risk factor for delayed diagnosis.

Conclusion: Febrile EPTB referred as FUO showed nonspecific clinical manifestations. The active application of cross-sectional imaging tests according to clinical clues or randomly in the absence of local manifestations, combined with invasive diagnostic approaches even for atypical presentations may lead to an earlier diagnosis of febrile EPTB.

Keywords: Extrapulmonary tuberculosis; FUO; Fever of unknown origin; Imaging study.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Institutional Review Board at Boramae Medical Center (30–2017-16), which waived the need for obtaining consent from the patients. All personal identifiers were anonymized for confidentiality before data processing was performed. This research was in compliance with the Helsinki Declaration.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study design. EPTB extrapulmonary tuberculosis, FUO fever of unknown origin, PTB pulmonary tuberculosis, TB tuberculosis
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